# 情境 22歲個案於故意服用acetaminophen 500 mg 30錠後6小時被送至ED。生命徵象穩定、無症狀；血中acetaminophen濃度於Rumack-Matthew nomogram位於毒性區。護理師預期使用的藥物為何?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375131&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PA

## 題目

情境 22歲個案於故意服用acetaminophen 500 mg 30錠後6小時被送至ED。生命徵象穩定、無症狀；血中acetaminophen濃度於Rumack-Matthew nomogram位於毒性區。護理師預期使用的藥物為何?

## 選項

1. IV或口服N-acetylcysteine(Mucomyst、Acetadote)負荷後維持21小時以上，最好於攝入8小時內開始。 **✔ 正確答案**
2. 立即給予單次劑量的 activated charcoal，因為在攝入後長達 12 小時內，它仍是建議用來結合 acetaminophen 的介入措施。
3. 靜脈注射 sodium bicarbonate 以鹼化尿液，並在大量攝入 acetaminophen 後增強腎臟對肝毒性 NAPQI 代謝物的排泄。
4. 以 IV push 方式靜脈注射 naloxone，逆轉意圖性 acetaminophen 過量後可能發生的類鴉片鎮靜作用。

**正確答案: 1**

## 解析

N-acetylcysteine (NAC、Mucomyst、Acetadote)為acetaminophen毒性的解毒劑。NAC可補充肝臟glutathione並中和毒性代謝物NAPQI。Rumack-Matthew nomogram (使用攝入4小時以後的濃度)決定治療閾值。攝入8小時內開始效果最佳；24小時內仍有效，肝損發生後也仍應治療。途徑：IV (Acetadote)用於不耐口服、GI出血、暴發性肝衰、懷孕者；標準IV：150 mg/kg負荷60分鐘、50 mg/kg 4小時、100 mg/kg 16小時，若肝損確立則延長。口服：140 mg/kg負荷、70 mg/kg q4h共17次；強烈硫(臭蛋)味會引起噁心，配果汁/汽水、止吐藥、NG管。Sodium bicarbonate、6小時後僅給活性碳、naloxone皆不處理肝毒機制。活性碳僅於攝入1~2小時內輔助有效，6小時太晚。

## 深入解析

盡早給NAC，8小時內最佳，重症優先IV。Rumack-Matthew nomogram決定使用，肝毒於2~4日才出現，不可等症狀。

## 重要概念

- **N-acetylcysteine** — Mucomyst、Acetadote，acetaminophen解毒，glutathione前驅物，結合NAPQI
- **Rumack-Matthew nomogram** — 使用攝入4小時以後的acetaminophen濃度決定治療閾值
- **NAPQI** — acetaminophen毒性代謝物，glutathione耗盡時造成肝細胞傷害

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