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摘要
BackgroundThe licensed intravenous acetylcysteine regimen for treating paracetamol overdose in most countries uses three separate infusions over 21h. This complex regimen, requiring different infusion concentrations and rates, has been associated with administration errors. The aim of the present study was to assess the extent of administration delays occurring during this acetylcysteine regimen. MethodA 6-month retrospective observational study was conducted at three English teaching hospitals with clinical toxicology services from October 2014. Patients aged 16years and over, treated with intravenous acetylcysteine for paracetamol overdose, were included. The start times for infusions were recorded and the delays compared with the prescribed infusion times were calculated. Anaphylactoid reactions, intravenous cannula problems, overdose intent and smoking status were recorded to assess their contribution to delays. ResultsFrom 263 cases identified, 198 met the study inclusion criteria. The median time between the start of infusions 1 and 3 was delayed from the intended 5h by a median (interquartile range) of 90 (50-163) min, with 135 (68%) cases delayed by more than 1h. Significantly longer delays were observed in patients with anaphylactoid reactions [median delay 267 (217-413) min, n=8] and accidental/supratherapeutic overdose [median delay 170 (95-260) min, n=29]. There were no significant differences between smokers and nonsmokers, or for patients with intravenous cannula problems. ConclusionLong delays were identified during the three-infusion acetylcysteine regimen for the treatment of paracetamol overdose. These were of clinical significance and could lead to periods of subtherapeutic plasma acetylcysteine concentrations and potentially avoidable hepatotoxicity, as well as delaying hospital discharge.
- 出版日期2016-11
