小结
定义
病史和体格检查
关键诊断因素
- 自我伤害未遂
- 为缓解疼痛反复应用非处方止痛药
- 无症状就诊
- 恶心、呕吐或腹痛
- 右上腹疼痛和压痛
- 黄疸
- 意识模糊、意识水平下降和/或扑翼样震颤
危险因素
- 自我伤害史
- 为缓解疼痛而频繁或重复服药的病史
- 谷胱甘肽缺乏
- 肝药酶诱导剂（CYP 450 诱导剂）
诊断性检查
首要检查
- 血清对乙酰氨基酚水平
- 血清 AST 和 ALT 水平
- 动脉血 pH 值和乳酸水平
- 尿素和电解质或肾功能检查
- 血清凝血酶原时间和 INR
需考虑的检查
- 血清水杨酸水平
- 尿液药物筛查
治疗流程
急性单次摄入
累积摄入对乙酰氨基酚
反复治疗性过量摄入对乙酰氨基酚：有肝毒性体征
反复治疗性过量摄入对乙酰氨基酚：无肝毒性体征
撰稿人
作者
Daniel K. Colby, MD
Assistant Professor
Division of Medical Toxicology
Department of Emergency Medicine
UC Davis Health
CA
利益声明
DKC declares that he has no competing interests.
Alastair Newton, MB ChB, FCEM
Consultant in Emergency Medicine
Emergency Department
The Prince Charles Hospital
Brisbane
Queensland
Australia
利益声明
AN declares that he has no competing interests.
鸣谢
Professor Kennon Heard and Dr Alastair Newton would like to gratefully acknowledge Professor Allan R. Mottram, a previous contributor to this topic. ARM declares that he has no competing interests.
同行评议者
Scott Phillips, MD
Clinical Faculty
Department of Toxicology
Rocky Mountain Poison & Drug Center
Denver
CO
利益声明
SP declares that he has no competing interests.
Gerald F. O'Malley, DO
Director
Division of Research
Department of Emergency Medicine
Albert Einstein Medical Center
Philadelphia
PA
利益声明
GFOM declares that he has no competing interests.
Sophie Gosselin, MD, FRCPC
Associate Professor
Department of Medicine
McGill University
Emergency Physician and Medical Toxicologist
McGill University Health Centre
Medical Toxicologist
Centre Antipoison du Québec
Montreal
Quebec
Canada
利益声明
SG declares that she is an unpaid co-investigator in the Canadian Acetaminophen Overdose Study and unpaid co-chair of the Extracorporeal Treatment In Poisoning workgroup.
鉴别诊断
- 休克肝
- 急性甲型肝炎
- 急性乙型肝炎
更多 鉴别诊断指南
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- 毒理学数据库：对乙酰氨基酚过量
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