Does the patient history predict hepatotoxicity after acute paracetamol overdose?

QJM : Monthly Journal of the Association of Physicians
W Stephen WaringJanice M Pettie

Abstract

Initial management of patients who were presented to hospital after acute paracetamol overdose depends on the suspected amount ingested and more than 12 g is potentially fatal. However, the validity of this approach has received comparatively little attention. The present study is sought to establish whether the stated paracetamol dose might predict systemic exposure and risk of hepatotoxicity. A prospective observational study of consecutive patients presenting to the Emergency Department due to acute paracetamol overdose was performed. Serum paracetamol concentrations between 4 and 15 h post-ingestion were compared with the Rumack-Matthew '200-line' nomogram, and hepatotoxicity was defined by prothrombin time ratio >1.3 or alanine transaminase > or =1000 U/l. There were 987 patients, and the stated quantity of paracetamol ingested was 0-12 g in 475 (48.1%), >12 g in 349 (35.4%) and unknown in 163 (16.5%). Ingestion of >12 g was associated with paracetamol concentration above the '200-line' in 31.8% (95% CI 27.1-36.9%) vs. 3.2% (1.9-5.2%), P < 0.0001 by chi2 proportional test, and associated with hepatotoxicity in 6.9% (4.6-10.1%) vs. 1.3% (0.5-2.8%), P = 0.0001. Therefore, ingestion of >12 g predicted higher paracetamol expos...Continue Reading

Citations

Nov 26, 2008·Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology·Suzanne BenhalimW Stephen Waring
Nov 11, 2011·Irish Journal of Medical Science·M IqbalP A McCormick
Feb 28, 2009·Proceedings of the National Academy of Sciences of the United States of America·Kai WangDavid J Galas
Oct 2, 2012·BMC Pharmacology & Toxicology·Abd-Rahman MarzilawatiSanjiv Mahadeva
Oct 23, 2012·Indian Journal of Pharmacology·S M D K Ganga SenarathnaB M Rohini Fernandopulle
Oct 2, 2014·European Journal of Clinical Pharmacology·Y LeangS L Greene
Jun 16, 2012·Expert Review of Clinical Pharmacology·W Stephen Waring
Jun 10, 2009·Expert Opinion on Drug Metabolism & Toxicology·Gordon Liss, James H Lewis
Oct 22, 2013·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·Hossein Sanaei-Zadeh
Nov 7, 2013·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·Geoffrey K Isbister, Stephen Brent Duffull
Jul 2, 2009·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·D Nicholas Bateman
Mar 12, 2013·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·S GosselinJ Caro
Nov 27, 2008·British Journal of Clinical Pharmacology·W Stephen WaringAnn Graham
Apr 19, 2012·Basic & Clinical Pharmacology & Toxicology·Thomas M ArmstrongW Stephen Waring
Dec 24, 2010·British Journal of Clinical Pharmacology·W Stephen WaringD Nicholas Bateman
Aug 4, 2011·Pharmacoepidemiology and Drug Safety·Sa'ed H ZyoudSyed Azhar Syed Sulaiman
Dec 2, 2008·The Journal of Toxicological Sciences·W Stephen Waring, Suzanne Benhalim
Apr 28, 2017·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·Anselm Wong, Andis Graudins
Apr 23, 2009·Age and Ageing·Martin W DoakW Stephen Waring
Sep 4, 2018·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·D Nicholas BatemanMichael Eddleston
Feb 20, 2019·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·Robert G Hendrickson
Dec 1, 2007·Basic & Clinical Pharmacology & Toxicology·W Stephen WaringOliver D G Robinson
Jul 16, 2014·World Journal of Hepatology·Claire Louise CrossanLinda Scobie
Dec 22, 2016·British Journal of Clinical Pharmacology·Daniel J B MarksShaun L Greene
Feb 20, 2021·TheScientificWorldJournal·Line BerhoumaJamil Selmi

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.

Related Papers

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
W Stephen WaringOliver D Robinson
Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists
S B Duffull, G K Isbister
Annals of Clinical Biochemistry
Ian M GodberDonogh Maguire
© 2021 Meta ULC. All rights reserved