第 34 节两处并入的核实记录（2026-10-14）
不新增条目，把两件事并进已有的第 1 条和第 2 条。标题只在末尾加字，原字未删；selfcheck.html 的 key「对乙酰氨基酚」和 docs/刚确诊慢性病之后.md 里的锚点「先看成分表，对乙酰氨基酚只能占一种」仍然匹配。
第 1 条：对乙酰氨基酚吃多了，没不舒服也当天去医院
标题加了「，吃多了没不舒服也当天去医院」。
国家药监局 2020 年第 15 号公告附件（湖南省药监局转载）
转载页：http://mpa.hunan.gov.cn/mpa/xxgk/tzgg/wjtz/202003/t20200311_11809335.html
附件 .doc 的实际路径是 .../202003/11809335/files/<id>.doc（转载页里写的相对路径，拼在月份目录下，不是拼在 t2020… 下），用 antiword 逐字取出。
- 附件 3《对乙酰氨基酚缓释制剂说明书修订要求》（files/6ce83db398bc4dad9f3ece5195f2d873.doc），缓释片和缓释干混悬剂两处：
【注意事项】项下增加"严格按说明书使用。成人或儿童过量服用无论是否出现不适症状，均应立即就诊。"以及"N-乙酰半胱氨酸是对乙酰氨基酚中毒的拮抗药，宜尽早应用，12小时内给药疗效满意，超过24小时疗效较差。"
- 附件 1《对乙酰氨基酚常释制剂处方药说明书修订要求》（files/a7a415fa8b844dc6931f76ec14d5010c.doc）第 4 点：
N-乙酰半胱氨酸是对乙酰氨基酚中毒的拮抗药，宜尽早应用，12小时内给药疗效满意，超过24小时疗效较差。
- 附件 2（非处方药，条目原来就引）没有「无论是否出现不适症状均应立即就诊」这句，只有出现肝损伤表现时「应立即停药并就医」。所以条目写的是「缓释制剂说明书要写明」，没有说所有说明书都写了。
Smilkstein 1988 NEJM
Europe PMC 题录：NEJM 319(24):1557-1562，DOI 10.1056/nejm198812153192401，PMID 3059186。摘要原文：
Hepatotoxicity developed in 6.1 percent of patients at probable risk when N-acetylcysteine was started within 10 hours of acetaminophen ingestion and in 26.4 percent of such patients when therapy was begun 10 to 24 hours after ingestion.
When given within eight hours of acetaminophen ingestion, N-acetylcysteine was protective regardless of the initial plasma acetaminophen concentration.
We describe the outcomes of 2540 patients with acetaminophen ingestions treated with a loading dose of 140 mg of oral N-acetylcysteine …
Among patients at high risk who were treated 16 to 24 hours after an acetaminophen overdose, hepatotoxicity developed in 41 percent--a rate lower than that among historical controls.
「probable risk」译成「按血药浓度判断可能伤肝的病人」（原文按初始血药浓度分档）。研究没有随机分组，只和历史病例比，写进了备注；证据等级维持 B。
MedlinePlus Acetaminophen
https://medlineplus.gov/druginfo/meds/a681004.html （In case of emergency/overdose 一段）：
If someone takes more than the recommended dose of acetaminophen, get medical help immediately, even if the person does not have any symptoms.
第 2 条：孩子的液体退烧药用药盒里的量具量，换了剂型别照旧的毫升数喂
标题加了「，液体退烧药用药盒里配的量具量」。说人话删掉了「孩子退烧，这三种药都别用」（标题已说）和「警告发出后病例少了九成多」（收益栏仍有 555 例到 36 例以下），给量具腾出位置，保持在 4 句内。
FDA 问答：婴儿液体对乙酰氨基酚的浓度变化
Single ingredient OTC liquid acetaminophen marketed for infants had been available in 80 mg/0.8 mL and 80 mg/mL concentrations, while the single ingredient OTC liquid acetaminophen marketed for children had been available in a 160 mg/5 mL concentration. Having two very different concentrations of liquid acetaminophen on the market increased the likelihood for dosing confusion and medication errors involving unintentional overdoses in children.
Do not mix and match dosing devices. … Only the dosing device provided with the product purchased to measure that product should be used to measure that product.
Q6. Can dosing devices from the old and new concentrations of liquid acetaminophen marketed for infants be interchanged? A. No. Dosing devices sold with different products should never be interchanged.
「约 3 倍」是按这两个浓度自算的：80 mg/0.8 mL = 100 mg/mL，160 mg/5 mL = 32 mg/mL，100 ÷ 32 ≈ 3.1。原 FDA 2011 年安全通告页（…addition-another-concentration-liquid-acetaminophen-marketed-infants）已 404，改引这份问答页。
MedlinePlus 同一页也写了：
Always use the measuring cup or syringe provided by the manufacturer to measure each dose of the solution or suspension. Do not switch dosing devices between different products; always use the device that comes in the product packaging.
Falagas 2010（家用茶匙容量）
Int J Clin Pract 64(9):1185-1189，DOI 10.1111/j.1742-1241.2010.02402.x，PMID 20653796。摘要原文：
A total of 71 teaspoons and 49 tablespoons were provided by the 25 women … When these utensils were filled with water, the volume capacity of the 71 teaspoons and 49 tablespoons ranged from 2.5 to 7.3 ml (the mean and the median volume was 4.4 ml).
注意 2.5 到 7.3 毫升这个范围是 71 把茶匙和 49 把汤匙合起来的，条目照此写成「71 把茶匙和 49 把汤匙，装满水后容量从 2.5 毫升到 7.3 毫升不等」，没有说成只是茶匙。
Yin 2014 Pediatrics（茶匙、汤匙单位与量错）
Pediatrics 134(2):e354-61，DOI 10.1542/peds.2014-0395，PMID 25022742。摘要原文：
Compared with parents who used milliliter-only, parents who used teaspoon or tablespoon units had twice the odds of making an error with the intended (42.5% vs 27.6%, P = .02; adjusted odds ratio=2.3; 95% confidence interval, 1.2-4.4) …
Furthermore, 16.7% used a nonstandard instrument. … Nonstandard instrument use partially mediated teaspoon and tablespoon-associated measurement errors.
研究对象是 2 家急诊的 287 名家长。条目只写了「剂量单位用茶匙、汤匙的家长」，没写成「用家里勺子的家长」，因为原文比的是单位。
看过但没引的
- Yin 2010 JAMA 304(23):2595-2602（200 种儿童非处方液体药，148 种带量具，其中 146 种量具刻度和说明书不一致）。讲的是厂家量具和说明书对不上，不直接支持「用药盒自带量具」，没引。
- 国内药监局说明书范本里关于液体制剂量具的统一要求：只查了 2020 年第 15 号的三个附件，没有相关句子；别的范本没查到，所以量具部分只有国外依据。
自检
node tools/check-plain.mjs：说人话 718 条，不合格 0 条。node tools/check-refs.mjs --check：1603 处全部通过。- 单条仍各 8 行。第 1 条备注约 520 字，第 2 条备注未改（约 660 字）。