Late Increase in Acetaminophen Concentration After Overdose of Tylenol Extended Relief

Bizovi, Kenneth; Aks, Steven E.; Paloucek, Frank; Gross, Robin; Keys, Niko; Rivas, Jaime

doi:10.1016/s0196-0644(96)70119-1

Cited by 42 publications

(18 citation statements)

References 7 publications

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“…Six articles addressing extended-release acetaminophen overdose were identified (27,28,(125)(126)(127)(128). Two studies were randomized, controlled (level 1b) pharmacokinetic comparisons with regular extra-strength acetaminophen in healthy volunteers taking simulated overdoses.…”

Section: Role Of Different Acetaminophen Formulationsmentioning

confidence: 99%

“…The other articles were case reports or case series (level 4) of overdoses with extended-release acetaminophen in which several patients were noted to have serum acetaminophen concentrations that crossed the nomogram line despite initially nontoxic serum concentrations (126)(127)(128). Hepatotoxicity developed in one patient who ingested a handful of extendedrelease acetaminophen and did not present to an emergency department until 19 hours after the ingestion where she was treated with acetylcysteine (125).…”

Section: Role Of Different Acetaminophen Formulationsmentioning

confidence: 99%

See 1 more Smart Citation

Acetaminophen Poisoning: an Evidence-Based Consensus Guideline for Out-of-Hospital Management

Dart

Erdman

Olson

et al. 2006

Clinical Toxicology

131

102

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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 evidencebased 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.

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Section: Role Of Different Acetaminophen Formulationsmentioning

confidence: 99%

Section: Role Of Different Acetaminophen Formulationsmentioning

confidence: 99%

Acetaminophen Poisoning: an Evidence-Based Consensus Guideline for Out-of-Hospital Management

Dart

Erdman

Olson

et al. 2006

Clinical Toxicology

131

102

View full text Add to dashboard Cite

show abstract

“…Nine additional cases of double hump pharmacokinetics have been reported previously [10][11][12][13][14][15][16][17]. The characteristics of all 12 cases of double peak acetaminophen concentrations are summarized in Table 4.…”

Section: Discussionmentioning

confidence: 99%

Bactrian (“Double Hump”) Acetaminophen Pharmacokinetics: A Case Series and Review of the Literature

et al. 2010

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After acute ingestion, acetaminophen (APAP) is generally absorbed within 4 h and the APAP concentration ([APAP]) slowly decreases with a predictable half-life. Alterations in these pharmacokinetic principles have been rarely reported. We report here three cases of an unusual double hump, or Bactrian, pattern of [APAP]. We review the literature to describe the case characteristics of these rare cases. A 38-year-old woman ingested 2 g hydrocodone/65 g acetaminophen. Her [APAP] peaked at 289 mcg/mL (8 h), decreased to 167 mcg/mL (31 h), then increased to 240 mcg/mL (39 h). She developed liver injury (peak AST 1603 IU/L; INR1.6). A 25-year-old man ingested 2 g diphenhydramine/26 g APAP. His [APAP] peaked at 211 mcg/mL (15 h), decreased to 185 mcg/mL (20 h), and increased again to 313 mcg/mL (37 h). He developed liver injury (peak AST 1153; INR 2.1). A 16-year-old boy ingested 5 g diphenhydramine and 100 g APAP. His [APAP] peaked at 470 mcg/mL (25 h), decreased to 313 mcg/mL (36 h), then increased to 354 mcg/mL (42 h). He developed liver injury (peak AST 8,686 IU/L; peak INR 5.9). We report three cases of Bactrian ("double hump") pharmacokinetics after massive APAP overdoses. Cases with double hump pharmacokinetics may be associated with large ingestions (26-100 g APAP) and are often coingested with antimuscarinics or opioids. Several factors may contribute to these altered kinetics including the insolubility of acetaminophen, APAP-induced delays in gastric emptying, opioid or antimuscarinic effects, or enterohepatic circulation. Patients with double hump APAP concentrations may be at risk for liver injury, with AST elevations and peaks occurring later than what is typical for acute APAP overdoses.

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“…Prolonged absorption has been reported several times [2][3][4] for extended release acetaminophen. Applying Equation 1 using the apparent half-life of elimination instead of t 1/2,el , is inadequate and results in a substantial underestimation of CL Total .…”

Section: Letters To the Editormentioning

confidence: 99%

“Massive Acetaminophen Ingestion with Early Metabolic Acidosis and Coma: Treatment with IV NAC and Continuous Venovenous Hemodiafiltration” by Wiegand et al., Clin Toxicol (Phila) 48:156–159

Bodmer

Monte

2010

Clinical Toxicology

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Late Increase in Acetaminophen Concentration After Overdose of Tylenol Extended Relief

Cited by 42 publications

References 7 publications

Acetaminophen Poisoning: an Evidence-Based Consensus Guideline for Out-of-Hospital Management

Acetaminophen Poisoning: an Evidence-Based Consensus Guideline for Out-of-Hospital Management

Bactrian (“Double Hump”) Acetaminophen Pharmacokinetics: A Case Series and Review of the Literature

“Massive Acetaminophen Ingestion with Early Metabolic Acidosis and Coma: Treatment with IV NAC and Continuous Venovenous Hemodiafiltration” by Wiegand et al., Clin Toxicol (Phila) 48:156–159

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