مرکز منطقه ای اطلاع رساني علوم و فناوري - بررسي فراواني عوارض جانبي ناشي از ان - استيل سيستيين وريدي در درمان مصرف بيش از حد استامينوفن

چكيده لاتين :

Background: Various kinds of drugs have been evaluated as antidotes of acetaminophen; the most important of them is N-acetylcysteine (NAC). The optimal route, dose and duration of administration for NAC kin the management of acetaminophen poisoning is controversial. Various anecdotal reports have mentioned development of adverse effects following intravenous NAC therapy that have restricted this form of usage. In Iran, it is unclear whether the use of intravenous NAC is associated with a significant incidence of adverse events. To investigate the frequency of adverse effects of intravenous NAC therapy, compare them with previous reports, and asses the safety of intravenous NAC therapy, we attempted to conduct this survey. Methods: This was a descriptive and prospective study, and was conducted at Loqman-Hakim Hospital in Tehran, Iran during a I -year period (1380). We included all adult patients who had a history of one toxic dose (7.5 gr or more) of acetaminophen intake and presenting fewer than 12 hours after consumption. These patients were treated regardless of the serum levels of acetaminophen. Patients with concurrent intoxication, coma and hepatic encephalopathy were excluded from the study. Treatment of these patients was carried out using 20-hour therapeutic protocol. There was a structured data collection form, submitted to all patients prospectively. A logistic regression analysis (based on the stepwise variable selection method) was carried out using SPSS Software, with the adverse reactions as the dependent variable, and age, sex, history of asthma, and medical allergy as independent variables. Results: Intravenous NAC was administrated to 206 adult cases. Adverse reactions to NAC were observed in 23.3% of patients. In none of the symptomatic poisoned individuals, we had to completely stop the IV NAC infusion. No patients developed any serious adverse effects requiring intensive care and there were no deaths. It was shown that there were no significant relationships between age, sex, asthma or medical allergy and side effects. Conclusion: On the basis of our findings, we concluded that not using the automatic infusion pump and also the low rate of hepatotoxicity would be expected to correspond with a high frequency of adverse effects. Despite the high frequency of adverse effects, they were transient, not life threatening, easily treated, and all patients received a complete course of intravenous NAC. Therefore, the treatment can be considered relatively safe in the management of acetaminophen poisoning.