アセトアミノフェン中毒
WordNet
- an analgesic for mild pain but not for inflammation; also used as an antipyretic; (Datril, Tylenol, Panadol, Phenaphen, Tempra, and Anacin III are trademarks of brands of acetaminophen tablets) (同)Datril, Tylenol, Panadol, Phenaphen, Tempra, Anacin III
- the physiological state produced by a poison or other toxic substance (同)toxic condition, intoxication
- the act of giving poison to a person or animal with the intent to kill
UpToDate Contents
全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.
English Journal
- Massive acetaminophen overdose: effect of hemodialysis on acetaminophen and acetylcysteine kinetics.
- Ghannoum M1, Kazim S2, Grunbaum AM3, Villeneuve E4, Gosselin S2,5.
- Clinical toxicology (Philadelphia, Pa.).Clin Toxicol (Phila).2016 Jul;54(6):519-22. doi: 10.1080/15563650.2016.1175006. Epub 2016 Apr 27.
- CONTEXT: Early onset acidosis from mitochondrial toxicity can be observed in massive acetaminophen poisoning prior to the development of hepatotoxicity. In this context, the efficacy of acetylcysteine to reverse mitochondrial toxicity remains unclear and hemodialysis may offer prompt correction of a
- PMID 27118496
- CCR2+ monocytes aggravate the early phase of acetaminophen induced acute liver injury.
- Mossanen JC1,2, Krenkel O1, Ergen C1, Govaere O3, Liepelt A1, Puengel T1, Heymann F1, Kalthoff S4, Lefebvre E5, Eulberg D6, Luedde T1, Marx G2, Strassburg CP4, Roskams T3, Trautwein C1, Tacke F1.
- Hepatology (Baltimore, Md.).Hepatology.2016 Jun 15. doi: 10.1002/hep.28682. [Epub ahead of print]
- Acetaminophen (APAP, paracetamol) poisoning is a leading cause of acute liver failure (ALF) in humans and induces hepatocyte necrosis, followed by the activation of the innate immune system further aggravating liver injury. The role of infiltrating monocytes during the early phase of ALF is still am
- PMID 27302828
- N-acetylcysteine regimens for paracetamol overdose: Time for a change?
- Wong A1,2, Graudins A2,3.
- Emergency medicine Australasia : EMA.Emerg Med Australas.2016 May 18. doi: 10.1111/1742-6723.12610. [Epub ahead of print]
- Paracetamol overdose is one of the commonest pharmaceutical poisonings in the world. For nearly four decades, intravenous acetylcysteine regimens have been used to treat most patients successfully and prevent or mitigate hepatotoxicity. However, the rate of occurrence of adverse reactions to acetyl
- PMID 27193944
Japanese Journal
- 特集 Pros & Cons アセトアミノフェン中毒の治療にノモグラムは有用か
- Serum acetaminophen concentrations after acute overdose are not altered by opioid co-ingestion
- Waring W. Stephen,Benhalim Suzanne
- Journal of toxicological sciences 33(5), 549-553, 2008-12-01
- … Serum acetaminophen concentrations are of critical importance in determining the need for acetylcysteine therapy after acute acetaminophen overdose. … Limited data suggest opioid co-ingestion might alter acetaminophen pharmacokinetics. … The present study was designed to examine serum acetaminophen concentrations after acute overdose, and to compare between patients that co-ingested an opioid and those that did not. …
- NAID 110007005554
- 急性中毒医療におけるアセトアミノフェン検出キット^[○!R]の臨床的有用性 : 新潟市民病院28症例の調査より
- 高山 真理子,藤澤 真奈美,堀 寧 [他],小田 明,勝山 新一郎,広瀬 保夫,山崎 佳苗,若林 広行
- 藥學雜誌 128(1), 159-163, 2008-01-01
- … In acute poisoning caused by acetaminophen (N-acetyl-p-aminophenol, APAP), it is critical to predict the onset of delayed liver injury based on the prompt measurement of serum APAP level and to administer the antidote N-acetyl-cysteine (NAC) without delay as needed. …
- NAID 110006533015
Related Links
- Lawsuits have been filed alleging that Acetaminophen manufacturers have failed to properly warn the public about the dangers of acetaminophen poisoning. ... Every year, acetaminophen is responsible for more cases of poisoning ...
- acetaminophen poisoning, a toxic reaction to the ingestion of excessive doses of acetaminophen. Dosages exceeding 140 mg/kg can produce liver failure, and larger doses can be fatal. Large amounts of acetaminophen metabolites ...
★リンクテーブル★
[★]
- 英
- acetaminophen poisoning
- 関
- アセトアミノフェン N-acetyl-p-aminophenol、薬物性肝障害
概念
- 多くの薬に含まれており、意図せずにたくさん飲んでいることもある → 規定量の数倍を飲むこともある
- 70kgの人 325mg x 20 中毒
- 40 死
症状
- 1. ～数時間 嘔吐
- 2. 24時間 嘔吐、腹痛1
- 3. 2-5日 嘔吐、肝機能↓、黄疸、出血、熱
- 4. 5日以降 直るか肝不全となる
病態生理
- 参考1
- アセトアミノフェンは肝臓で硫酸基やグルクロン酸抱合をうけ、尿より排泄され、2%が代謝を受けずにそのまま排泄される。排泄されないアセトアミノフェンは混合機能オキシダーゼによりN-acetyl-p-benzoquinoneimine(NAPQI)に変換される。この物質は毒性が高い、反応性が高い、電子親和性が高いという特徴を有する。このNAPQIは肝臓のグルタチオンにより無毒化されて尿中に排泄される。
- 過剰量のアセトアミノフェンが投与された場合、NAPQIを無毒化するグルタチオンが消費される。肝臓のグルタチオンが70-80%まで消費されると、NAPQIは肝細胞と反応しこれを障害する。 → 肝細胞障害型の薬物性肝障害をきたす。
治療
- 直後：活性炭投与
- 初期：N-アセチルシステインの投与(グルタチオンの補給)。経口、静注、1-数日
参考
- 1. [charged] Acetaminophen (paracetamol) poisoning in adults: Pathophysiology, presentation, and diagnosis - uptodate [1]
[★]
アセトアミノフェン