tailieunhanh - Báo cáo y học: "Acetaminophen poisoning: an update for the intensivist"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: Acetaminophen poisoning: an update for the intensivist. | Critical Care April 2002 Vol 6 No 2 Dargan and Jones Commentary Acetaminophen poisoning an update for the intensivist Paul I Dargan and Alison L Jones1 Specialist Registrar in Medicine and Clinical Toxicology National Poisons Information Service Guy s St Thomas NHS Trust London UK Consultant Physician and Clinical Toxicologist National Poisons Information Service Guy s St Thomas NHS Trust London UK Correspondence Paul Dargan Published online 14 March 2002 Critical Care 2002 6 108-110 2002 BioMed Central Ltd Print ISSN 1364-8535 Online ISSN 1466-609X Abstract Acetaminophen overdose is common and can result from deliberate nonstaggered or accidental staggered ingestion. Patients presenting within 24 h of an acetaminophen overdose can safely be managed on medical wards. Early management of nonstaggered overdose is guided by the plasma acetaminophen concentration whereas management of accidental staggered ingestion is guided by ingested dose. Ingested dose and time from ingestion to presentation are important prognostic factors in accidental staggered ingestion. Acetaminophen-induced acute liver failure ALF requires meticulous supportive care in an intensive care unit ICU with early identification and transfer of patients who are likely to require liver transplantation to a specialist liver centre. The modified King s College Hospital criteria incorporating lactate into the traditional criteria represent the best tool for identifying patients who require transplantation. Keywords accidental poisoning acetaminophen acute liver failure overdose transplantation Acetaminophen poisoning is common. In the UK 50 of poisoning admissions involve acetaminophen this figure is nearer 10 in the USA 1 2 . Acetaminophen poisoning can result from deliberate or accidental staggered ingestion. The present commentary discusses the differences in management of these two presentations and management of patients with established hepatotoxicity who require ICU