Journal of The Korean Society of Clinical Toxicology (대한임상독성학회지)

Korean society of Clincal Toxicology (대한임상독성학회)
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Factors of Determining N-acetylcysteine Administration in Patients with Acute Acetaminophen Poisoning

급성 아세트아미노펜 중독에서 N-acetylcysteine 투여 결정 관련 인자

  • Lee, Jeong Hwa (Department of Emergency Medicine, Sam Hospital) ;
  • Choi, Sangchun (Department Emergency Medicine, Ajou University School of Medicine) ;
  • Yoon, Sang Kyu (Department of Emergency Medicine, Sam Hospital) ;
  • Shin, Kyu Cheol (Department Emergency Medicine, Ajou University School of Medicine)
  • 이정화 (안양샘병원 응급의학과) ;
  • 최상천 (아주대학교 의과대학 응급의학과교실) ;
  • 윤상규 (안양샘병원 응급의학과) ;
  • 신규철 (아주대학교 의과대학 응급의학과교실)
  • Received : 2020.09.07
  • Accepted : 2020.10.26
  • Published : 2020.12.31
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Abstract

Purpose: In acute acetaminophen poisoning, the administration of N-acetylcysteine (NAC) can effectively treat the main complications, such as kidney injury and liver failure. In the current situation, measurements of the acetaminophen concentration are not checked in the usual medical facilities. Therefore, this study examined the factors of determining the administration of NAC in addition to the stated amount of intake. Methods: The medical records of patients who visited Ajou University Hospital emergency center with acetaminophen poisoning from January 2015 to December 2019 were reviewed retrospectively. One hundred and seventy-nine patients were initially included. Among these patients, 82 patients were finally selected according to the inclusion criteria in the study. The inclusion criteria were as follows: patients who were 15 years of age or older; those whose ingested dose, ingested time, and body weight were clearly identified; and patients whose acetaminophen sampling time was within 24 hours. Patients were divided into two groups: NAC administered vs. non-NAC administered. The following variables were compared in these two groups: ingested dose, ingested dose per body weight, hospital arrival time after ingestion, suicide attempt history, psychiatric disease history, classification of toxic/non-toxic groups, duration of hospitalization, and laboratory results. Results: Univariate analysis revealed the ingested dose per body weight, hospital arrival time after ingestion, suicide attempt history, and psychiatric disease history to be the determining factors in administering NAC. Logistic regression analysis confirmed that the ingested dose per body weight was the only significant factor leading to an NAC treatment decision. (Odds ratio=1.039, 95% Confidential interval=1.009-1.070, p=0.009) Conclusion: The ingested dose per body weight was the only determining factor for administering NAC in patients with acute acetaminophen poisoning. On the other hand, additional criteria or indicators for the NAC administration decision will be necessary considering the inaccuracy of the ingested dose per body weight and the efficiency of NAC administration.

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References

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