tailieunhanh - Báo cáo y học: "Prolonged N-acetylcysteine therapy in late acetaminophen poisoning associated with acute liver failure – a need to be more cautious"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Prolonged N-acetylcysteine therapy in late acetaminophen poisoning associated with acute liver failure – a need to be more cautious? | Available online http content 13 3 144 Commentary Prolonged -acetylcysteine therapy in late acetaminophen poisoning associated with acute liver failure - a need to be more cautious T Nimmi C Athuraliya and Alison L Jones Department of Clinical Pharmacology and Clinical Toxicology School of Medicine and Public Health Faculty of Health University of Newcastle Callaghan Drive Newcastle NSW 2308 Australia Corresponding author Alison L Jones Published 14 May 2009 This article is online at http content 13 3 144 2009 BioMed Central Ltd Critical Care 2009 13 144 doi cc7800 See related research by Yang et al. http content 13 2 R55 Abstract Since the 1970s N-acetylcysteine NAC has shown proven efficacy as an antidote for acetaminophen APAP poisoning and APAP-induced liver failure for early presenters. The current evidence of benefits of NAC for late presenters is controversial because of the poor understanding of the mechanism of late toxicity. In the previous issue of Critical Care Yang and colleagues use a mouse model to demonstrate that NAC in doses similar to those used therapeutically to treat APAP poisoning in humans impairs liver regenerative capacity and that the effect is more pronounced when administered for a longer duration. Studies based on cell cultures support this evidence. Cytokine and growth factor signalling pathways are recognised to be involved in the process of liver regeneration and apoptosis. This research paper generates several issues related to the future management of APAP-induced liver failure and research into the mechanism of toxicity especially of late toxicity. Introduction The paper entitled Prolonged treatment with N-acetyl-cysteine delays liver recovery from acetaminophen hepatotoxicity by Yang and colleagues 1 published in the previous issue of Critical Care demonstrates that prolonged administration of N-acetylcysteine NAC at 100mg kg in acetaminophen APAP -induced