Use of activated charcoal in a simulated poisoning with acetaminophen: a new loading dose for N-acetylcysteine?
| Autor: | Chamberlain JM; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC., Gorman RL, Oderda GM, Klein-Schwartz W, Klein BL |
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| Jazyk: | angličtina |
| Zdroj: | Annals of emergency medicine [Ann Emerg Med] 1993 Sep; Vol. 22 (9), pp. 1398-402. |
| DOI: | 10.1016/s0196-0644(05)81985-7 |
| Abstrakt: | Study Objectives: To investigate the ability of a supranormal dose of N-acetylcysteine to overcome the effects of activated charcoal on N-acetylcysteine bioavailability and to determine the effects of activated charcoal on serum acetaminophen levels. Design, Setting, and Participants: Ten healthy adult volunteers participated in a controlled cross-over experiment. During phase I (control), subjects ingested 3 g acetaminophen, followed one hour later by the normal loading dose of N-acetylcysteine (140 mg/kg). During phase II (charcoal), subjects ingested 3 g acetaminophen, followed one hour later by 60 g activated charcoal and a supranormal loading dose of N-acetylcysteine (235 mg/kg). Main Outcome Measures: Serum levels of N-acetylcysteine were measured every 30 minutes for six hours. A serum acetaminophen level was measured at four hours. Results: The area under the curve for N-acetylcysteine was significantly higher for phase II than phase I (P < .05, two-tailed paired t-test). Peak N-acetylcysteine and time to peak were not significantly different. The four-hour serum acetaminophen level was significantly lower for phase II than phase I (P < .05, two-tailed paired t-test). Diarrhea occurred during both phases, but N-acetylcysteine was otherwise well tolerated. Conclusion: These results suggest that activated charcoal can be used safely for victims of acetaminophen overdose. A beneficial effect in preventing acetaminophen absorption can be expected if it is given within one hour after ingestion. If N-acetylcysteine is needed because of a toxic serum acetaminophen level, bioavailability can be ensured by increasing the N-acetylcysteine loading dose from 140 mg/kg to 235 mg/kg. |
| Databáze: | MEDLINE |
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