Saturday, 17 October 2015
Hall D1 Foyer (Floor 3) (Coex Convention Center)
Young-Hee Nam, MD
,
Internal Medicine, Dong-a University School of Medicine, Busan, South Korea
Dong Sub Jeon, MD
,
Internal Medicine, Dong-a University School of Medicine, Busan, South Korea
Hee-Joo Nam
,
Dong-a University Hospital Regional Pharmacovigilance Center, Busan, South Korea
Yeo Myeong Noh, Nurse
,
Dong-a University Hospital Regional Pharmacovigilance Center, Busan, South Korea
Sang Hee Kim Kim, Nurse
,
Dong-a University Hospital Regional Pharmacovigilance Center, Busan, South Korea
Ye Suel Park
,
Dong-a University Hospital Regional Pharmacovigilance Center, Busan, South Korea
Soo-Keol Lee, MD, PhD
,
Internal Medicine, Dong-a University School of Medicine, Busan, South Korea
Acetaminopen is one of the drugs most commonly used in intentional self-poisoning. N-acetylcysteins (NAC) is an effective antidote for acetaminophen overdose, which is usually given intravenously for 20-36 hour. When used intravenously, NAC can cause anaphylactoid reactions. Most of the adverse reactions are cutaneous manifestation involving flushing, pruritus, rash and urticaria. However, a few are systemic reactions, such as bronchospasm and hypotension. The etiology of the anaphylactoid reaction is not entirely understood, and the data are conflicting. No study has been conducted to evaluated the IgE response to rule out a true anaphylactic reaction to intravenous NAC. They typically occur within 15-60 minute after NAC infusion and appear to be dose related rather than true anaphylaxis. We report a case of anaphylactoid reactions to NAC has not yet been reported in Korea.
A 17-year-old female was admitted via emergency department. She had 2-year history of depression. She ingested 20 tablets of Geworin®(isoporylantipyrine 150mg, acetaminophen 300mg) in a suicide attempt precipitated by a family quarrel. She suffered from dizziness and vomiting. Gastric lavage was done and then she was immediately treated with NAC. The standard regimen consists of intravenous infusion of NAC 150 mg/kg as a bolus, 50 mg/kg over 4h and repeated infusions of 100 mg/kg over 16h until three consecutive recovering values of the INR have been demonstrated. Immediately after infusion of NAC, she developed generalized urticaria, nausea, vomiting, chest tightness, dyspnea, and hypotension. Administration of NAC was stopped, epinephrine and antihistamine was administered. Additionally activated charcoal was used to prevent drug absorption. Laboratory abnormalities was not seen including serum tryptase. She recovered completely without any sequelae within 24hours.
Acknowledgement
This research was supported by a grant from Ministry of Food and Drug Safety to operation of the regional pharmacovigilance center in 2015.
