وريدي در مسموميت با استامينوفن NAC بررسي عوارض جانبي درمان باان استيل سيستيين

ADVERSE EFFECTS OF I .V N-ACETYL CYSTEINE IN ACETAMINOPHEN POISONING TREATMENT

Acetaminophen poisoning is one of the most common drug poisoning in the world. N-acctyl cysteine (NAC) is a glutathione precursor with enhancing glutathione synthesis and increasing the amount of acetaminophen that is metabolized by sulfation. This antidote is used in PU and IV route but in some countries like U.S. IV form is not used and an on-going clinical trial of IV NAC is currently being conducted. This study done a cross-sectional research over adverse effects of 1V NAC administration during one year in adults who had ingested toxic dose of acetaminophen and were referred to Tehran Loghman Hospital Poison Center. Results from 206 patients showed that male to female ratio was I to 1.6 . 130 patients developed adverse effects after IV NAC administration including nausea and vomiting in 118 cases (57.2% ) and anaphylactoid reactions in 48 cases (23.3%). Among the patients who developed nausea & vomiting. 77 cases were managed with a single IV dose of metoclopromide and in patients with anaphylactoid reactions . 26 cases were managed with antihistaminic medication and corticosteroid therapy , while others were managed by decreasing in infusion rate or temporary stopping of NAC administration. In spite of IV NAC administration in all of the cases, mortality was not reported . Also , mild signs of adverse effects in most cases occurred which was controlled with single curative drugs or decreasing in infusion rate of IV NAC. It is recommended that IV NAC can be used as the first step in management of cases ingested toxic dose of acetaminophen (after primary supportive care in all poisoning) , even if there is not any ability of serum acetaminophen level assay.