Interventions for paracetamol (acetaminophen) overdose

Brok, Jesper; Buckley, Nicholas A.; Gluud, Christian

doi:10.1002/14651858.cd003328.pub2

Cited by 149 publications

(83 citation statements)

References 110 publications

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“…Indications suggested for the treatment can be found on Ta- ble 1. A toxic dose would be greater than 150-200 mg/kg, 13,15 and our patient received a higher dose with blood drug levels well beyond the "treatment line" (Figure 1).…”

Section: Discussionmentioning

confidence: 91%

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Medication error in an extremely low birth weight newborn: paracetamol overdose

Brener¹

2013

Arch Argent Pediat

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Errors are part of human nature and are usually present in our actions. Medical errors occur quite often and can be serious. Medication errors are among the most frequent, especially in newborn infants because of the multiple steps that occur during the process of prescribing and administering drugs and because most drugs are not licensed for being used in newborn infants (off-label). The aim of this report is to describe a medication error in prescribing paracetamol for closing a patent ductus arteriosus in a preterm infant and to analyze its causes. A preterm female infant born at 27 weeks of gestational age with a birth weight of 750 g received paracetamol at 9 days old at a dose 20 times greater than required. The initial plasma level was 480 µg/mL. N-acetylcysteine was administered and her clinical outcome was satisfactory. Parents were notified of the event, which was recorded in the medical record and in the electronic error reporting system of the Hospital Italiano de Buenos Aires. We consider this report as an example that we are exposed to making mistakes and should maximize precautions to improve patient safety in neonatal units.

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Section: Discussionmentioning

confidence: 91%

“…15 However, N-acetylcysteine has been used as an antidote, 12,13 by adapting alignment charts of studies performed in adults. Indications suggested for the treatment can be found on Ta- ble 1.…”

Section: Discussionmentioning

confidence: 99%

Medication error in an extremely low birth weight newborn: paracetamol overdose

Brener¹

2013

Arch Argent Pediat

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“…A strong risk benefit ratio favouring treatment and a desire to simplify the decision process have led to different treatment thresholds internationally, but the lower thresholds are not supported by evidence from randomized controlled trials [17,18]. In Denmark, all patients with suspected paracetamol overdose receive antidote [19].…”

Section: Antidote Treatment Thresholds In Different Countriesmentioning

confidence: 99%

“…For patients who have taken a potentially toxic dose, intravenous NAC over 20.25 hours is recommended for admissions more than 8 hours after acute overdose, staggered overdoses and those having vomiting and abdominal pain [24]. Oral methionine is recommended for patients presenting within 8 hours and not having vomiting or history of liver disease as it is a more cost effective alternative in the absence of studies proving superiority of NAC [17,18,27,28].…”

Section: Antidote Treatment Thresholds In Different Countriesmentioning

confidence: 99%

Paracetamol overdose: Relevance of recent evidence for managing patients in Sri Lanka

Galappatthy

Dawson²

2015

Ceylon Med. J.

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“…NAC also has anti-oxidant and proglutathione (pro-GSH) activities that support its therapeutic use in patients with oxidative stress (2). Its main clinical applications include the treatment of acetaminophen (paracetamol) overdose, chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, contrast-induced nephropathy and influenza pneumonia (3,4). NAC was further described as a chelating agent, notably of methylmercury, a glutamate precursor and a methyl donor allowing the conversion of homocysteine to methionine (5-7).…”

Section: Introductionmentioning

confidence: 99%

N-acetylcysteine: an old drug with variable Anti-influenza properties

Casanova

Garigliany

2016

jcbmr

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N-acetylcysteine (NAC) is a mucolytic drug commonly used as an adjuvant therapy in patients with respiratory conditions associated with excessive mucus production. NAC also has anti-oxidant activities that proved useful in the management of oxidative stress. These anti-oxidant capacities of NAC are mostly indirect, via a pro-glutathione effect where NAC provides L-cysteine residues required for glutathione synthesis. This activity is thought to be the basis for the protective effect of NAC administration in influenza patients and in mouse models of the disease. NAC was shown to limit lung inflammation, damage associated with the virus, and viral growth, at least in vitro. However, the anti-viral activity was highly variable depending on the influenza A strain. The reasons for these inter-strain variations are still unknown, but might be related to the level of nuclear factor-κB activation required for the virus to achieve its infectious cycle.

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Interventions for paracetamol (acetaminophen) overdose

Abstract: Analysis 9.1. Comparison 9 Intravenous N-acatylcysteine versus 'placebo' in patients with fulminant hepatic failure (randomised trials), Outcome 1 Mortality. .

Cited by 149 publications

References 110 publications

Medication error in an extremely low birth weight newborn: paracetamol overdose

Medication error in an extremely low birth weight newborn: paracetamol overdose

Paracetamol overdose: Relevance of recent evidence for managing patients in Sri Lanka

N-acetylcysteine: an old drug with variable Anti-influenza properties

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