No abstract

Timely assessment of acetaminophen concentration in overdose situations is not always available in resource‐poor settings. The 150 mg/kg dose‐estimate for acetaminophen is widely considered as criterion for acetaminophen overdose. Its sensitivity and specificity when compared to the 150 mg/L treatment line on the Rumack‐Matthew Nomogram (150‐treatment line) has rarely been evaluated. This is a retrospective chart review of acute acetaminophen overdose patients. We evaluated the sensitivity and specificity of the 150, 200 mg/kg and 8‐ and 10‐g dose‐estimates by plotting the serum acetaminophen levels and using 150‐treatment line on the Nomogram as the treatment cut‐off. A comparison of medical care costs was performed. We enrolled 784 cases for analysis. Median (IQR) age was 23 (20–28) years (81.9% female). There were 545 cases (69.5%) where the estimated ingested acetaminophen dose were ≥150 mg/kg and 406 cases (51.8%) with concentrations ≥150‐treatment line. Hepatotoxicity and acute liver injury (ALI) occurred in 7.3% and 23.9%, respectively. The sensitivity and specificity of 150 mg/kg dose‐estimate for the 150‐treatment line were 92.6% (95% CI 89.6, 94.8) and 55.3% (95% CI 50.3, 60.2). Among patients with dose‐estimate below150 mg/kg, none developed hepatotoxicity and 17 (7.1%) develop ALI. The administration of activated charcoal significantly decreased the risk of being above the 150‐treatment line by half. In resource‐poor setings, the use of 150 mg/kg dose‐estimate as a stand‐alone criteria for initiation of N‐acetylcysteine therapy is satisfactory, especially when combined with decontamination with activated charcoal and follow up of aminotransferase at 24 h.

Objective: AcetaCalc was used to evaluate Psi’s accuracy in predicting cases that required prolonged NAC therapy, as well as Psi’s optimal cut-off.Materials and Methods: This is a retrospective study of patients with acute paracetamol overdose who were treated with NAC at Siriraj Hospital between 2007 and 2016. The Psi parameter was calculated using the Acetacalc after entering paracetamol concentrations, blood sampling times, and NAC onset times. Indications for NAC continuation is in accordance with the guidelines, which recommended that NAC treatment be continued if the follow-up aminotransferase reached 50 U/L or higher.Results: We enrolled 403 patients, the proportion of NAC prolongation was 50.4 %. Psi was shown to be a significant predictor of NAC prolongation (p < 0.001) with area under the receiver operational characteristics curve 0.766 (95% confidence interval (CI) 0.719-0.813). The Psi cutoff with highest Youden index was 1.757 mM-hour. The sensitivities and specificities of the cutoff were 0.517 (95% CI 0.449-0.585) and 0.940 (95% CI 0.898-0.965), respectively.Conclusion: Psi parameter calculated through AcetaCalc is a useful tool for the prediction of cases where extension of NAC therapy beyond the standard regimen is indicated.