A Basis for the Decision to Rule in or out Acetaminophen Toxicity: Assessment of the Serum Level Within 4 Hours Post Overdose (original) (raw)

Puzzling Situation of Acetaminophen Toxicity in a Referral Hospital, Tehran, Iran

Iranian Journal of Pharmaceutical Sciences, 2018

Acetaminophen carries a higher risk of overdose. A puzzling situation of acetaminophen toxicity was encouraging enough to explore the epidemiologic situation of acetaminophen toxicity and its outcomes among patients acquired poisoning. This cross-sectional study retrospectively reviewed the medical records of 185 patients with acetaminophen poisoning referred to Loghman Hakim Hospital. Toxicity determined by acetaminophen serum concentration and time elapsed after drug ingestion. Demographics, laboratory markers, toxic hepatitis, renal failures, and liver enzyme elevations were compared between toxic and non-toxic patients. Twelve cases belonged to the former group and 173 patients fitted with the latter one. Having a mean age of 24.27±7.19 and 21.58±3.47 years, respectively, females were predominant. The average serum acetaminophen level was 70.37±61.92 and 24.90±26.36 within toxic and nontoxic patients, respectively. Median of consumed tablets were estimated as 40 for non-toxic and 18 for toxic patients (p=0.017). Mean hospital stay was 1.75±1.05 days for toxic patients and 1.35±3.25 days for the non-toxic group (p-value<0.001), and of whom 92.4 % were discharged within the first day. The laboratory assessments revealed no significant difference between groups. No death was recorded. Whereas hepatotoxicity was present in three toxic patients, renal failure was predominant in non-toxic patients. Rarely, a rise in liver enzyme was noticed; however, 33.33 % of toxic and 2.31 % of the non-toxic group had elevated AST; and 33.33 % of toxic versus 1.73 % percent of non-toxic patients had increased ALT. Acetaminophen toxicity is a worldwide noteworthy cause of poisoning which has distinct mortality and morbidity rates and showed an amazing and undebatable poisoning effect in the present study. A comprehensive study is required to examine the possible reasons for the difference between Iranian acetaminophen products with other non-Iranian company products.

Acetaminophen overdose: What practitioners need to know

Clinical Liver Disease, 2014

Overview and Epidemiologic Considerations Acetaminophen (APAP) is a highly effective analgesic and antipyretic agent that is safely used by millions of people every day. However, APAP is also a dose-dependent hepatotoxin that is present in over 600 marketed products and can cause acute pericentral liver injury when taken in doses exceeding 6 to 10 grams/day (Table 1). APAP overdose is the most common cause of drug-induced liver injury in the United States, with 60,000 cases reported each year, and also accounts for nearly 50% of adult acute liver failure (ALF) cases. 1 Intentional APAP overdose as a suicide gesture accounts for a majority of these cases, but there has been a significant increase in nonintentional APAP overdose cases over the past 2 decades. 2 Overall mortality remains low (< 1%) in intentional APAP overdose patients who receive NAC promptly. However, nearly 50% of the APAP ALF cases are attributed to ''therapeutic misadventures''-patients who frequently ingest multiple APAP-containing products and present with more advanced encephalopathy and liver injury. 3 Because there are at least 500 deaths each year in the United States attributed to APAP overdose, there are increasing calls for regulatory actions regarding APAP dosing, dispensing, packaging, and coformulation with opioid analgesics.

Predicting risk in patients with acetaminophen overdose

Expert Review of Gastroenterology & Hepatology, 2013

Acetaminophen (APAP) overdose is a very common cause of drug overdose and acute liver failure in the US and Europe. Mechanism-based biomarkers of APAP toxicity have the potential to improve the clinical management of patients with large dose ingestions of APAP. The current approach to the management of APAP toxicity is limited by imprecise and time-constrained risk assessments and late-stage markers of liver injury. A recent study of "low-risk" APAP overdose patients who all received treatment with N-acetylcysteine, found that cell-death biomarkers were more sensitive than alanine aminotransferase (ALT) and APAP concentrations in predicting the development of acute liver injury. The data suggest a potential role for new biomarkers to identify "low risk" patients following APAP overdose. However, a practical and ethical consideration that complicates predictive biomarker research in this area is the clinical need to deliver antidote treatment within 10 hours of APAP overdose. The treatment effect and time-dependent nature of N-acetylcysteine treatment must be considered in future "predictive" toxicology studies of APAPinduced liver injury.

Acetaminophen Serum Levels in Patients with unknown Poisoning and Loss of Consciousness

Advances in Bioscience and Clinical Medicine

Background: The aim of this study was to evaluate the serum levels of acetaminophen in patients with unknown poisoning and loss of consciousness, and to assess whether measuring serum acetaminophen level in all patients with drug overdose or decreased level of consciousness changes outcome. Methods & Materials: In a descriptive-analytical study, 300 patients with loss of consciousness and a history of drug toxicity with an unknown drug that referred to the emergency unit constituted the study sample. Serum acetaminophen levels of patients, the outcome, mortality, and morbidity of patients were evaluated. Results: The mean age of patients was 28.88±8.67 years. The minimum age of patients was 15 years and the maximum age of patients was 58 years. The mean serum level of acetaminophen in patients was 0.62±0.55 μg/ml. The highest level and the lowest level of acetaminophen in patients were 2.8 μg/ml and 0.2 μg/ml respectively. Serum acetaminophen level in patients was less than the toxi...

Acetaminophen, a therapeutic or an extremely toxic remedy – a review

Journal of Mind and Medical Sciences

When a new coronavirus appeared in the late 2019, identified as the cause of several cases of pneumonia in Wuhan, Paracetamol was initially reported to be the preferable antipyretic medication, choice which was detrimental to the use of other drugs. People have resorted to buying large stocks of Paracetamol and some have used it in large doses, regardless of the consequences. However, the Paracetamol (Acetaminophen) overdose remains the leading cause of death or transplantation due to acute liver failure in many parts of the world. This review aims at presenting the pharmacokinetics, the clinical signs, and the risk factors for systemic toxicity associated with Paracetamol overdose, as well as the current therapeutic approach. Paracetamol is primarily metabolized in the liver, by glucuronidation and sulfation. In case of a Paracetamol overdose, a large amount of NAPQI is conjugated with glutathione, and this process is due to a major depletion of glutathione, thus leading to hepatic...

Acetaminophen poisoning: an evidence-based consensus guideline for out-of-hospital management

Clinical toxicology (Philadelphia, Pa.), 2006

The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and initial management of patients with suspected ingestions of acetaminophen. An evidence-based expert consensus process was used to create this guideline. This guideline applies to ingestion of acetaminophen alone and is based on an assessment of current scientific and clinical information. The expert consensus panel recognizes that specific patient care decisions may be at variance with this guideline and are the prerogative of the patient and the health professionals providing care. The panel's recommendations follow. These recommendations are provided in chronological order of likely clinical use. The grade of recommendation is provided in parentheses. 1) The initial history obtained by the specialist in poison information should include the patient's age and intent (Grade B), the specific formulation and dose of acetaminophen, the ingestion pattern (single or ...

Predicting mortality from acetaminophen poisoning shortly after hospital presentation

Aims: Early identification of patients likely to die after acetaminophen (APAP) poisoning remains challenging. We sought to compare the sensitivity and time to fulfilment (latency) of established prognostic criteria. Methods: Three physician toxicologists independently classified every in-hospital death associated with APAP overdose from eight large Canadian cities over three decades using the Relative Contribution to Fatality scale from the American Association of Poison Control Centres. The sensitivity and latency were calculated for each of the following criteria: King's College Hospital (KCH), Model for End Stage