대한임상독성학회지 (Journal of The Korean Society of Clinical Toxicology)

  • 제21권2호
  • /
  • Pages.128-134
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  • 2023
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  • 1738-1320(pISSN)
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  • 2508-6332(eISSN)
대한임상독성학회 (Korean society of Clincal Toxicology)
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약물농도를 알 수 없는 환경에서 acetaminophen 급성 중독환자의 안전한 N-acetylcysteine 치료 종료를 위한 혈중약물 검출 예측

Predicting serum acetaminophen concentrations in acute poisoning for safe termination of N-acetylcysteine in a resource-limited environment

  • 김다해 (가톨릭대학교 성빈센트병원 응급의학과) ;
  • 차경만 (가톨릭대학교 성빈센트병원 응급의학과) ;
  • 소병학 (가톨릭대학교 성빈센트병원 응급의학과)
  • Dahae Kim (Department of Emergency Medicine, St. Vincent's Hospital) ;
  • Kyungman Cha (Department of Emergency Medicine, St. Vincent's Hospital) ;
  • Byung Hak So (Department of Emergency Medicine, St. Vincent's Hospital)
  • 투고 : 2023.09.26
  • 심사 : 2023.10.18
  • 발행 : 2023.12.31
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초록

Purpose: The Prescott nomogram has been utilized to forecast hepatotoxicity from acute acetaminophen poisoning. In developing countries, emergency medical centers lack the resources to report acetaminophen concentrations; thus, the commencement and cessation of treatment are based on the reported dose. This study investigated risk factors that can predict acetaminophen detection after 15 hours for safe treatment termination. Methods: Data were collected from an urban emergency medical center from 2010 to 2020. The study included patients ≥14 years of age with acute acetaminophen poisoning within 15 hours. The correlation between risk factors and detection of acetaminophen 15 hours after ingestion was evaluated using logistic regression, and the area under the curve (AUC) was calculated. Results: In total, 181 patients were included in the primary analysis; the median dose was 150.9 mg/kg and 35 patients (19.3%) had acetaminophen detected 15 hours after ingestion. The dose per weight and the time to visit were significant predictors for acetaminophen detection after 15 hours (odds ratio, 1.020 and 1.030, respectively). The AUCs were 0.628 for a 135 mg/kg cut-off value and 0.658 for a cut-off 450 minutes, and that of the combined model was 0.714 (sensitivity: 45.7%, specificity: 91.8%). Conclusion: Where acetaminophen concentrations are not reported during treatment following the UK guidelines, it is safe to start N-acetylcysteine immediately for patients who are ≥14 years old, visit within 15 hours after acute poisoning, and report having ingested ≥135 mg/kg. Additional N-acetylcysteine doses should be considered for patients visiting after 8 hours.

키워드

과제정보

본 연구를 위한 독성 데이터 수집에 헌신적인 노력을 해 준 성빈센트병원 응급의료센터 조은수 선생님께 본 지면을 빌어 깊은 감사를 전한다.

참고문헌

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