Management of acute paracetamol poisoning in a tertiary care hospital

Senarathna, S M D K Ganga; Ranganathan, Shalini Sri; Dawson, Andrew; Buckley, Nicholas A.; Fernandopulle, B. M. R.

doi:10.4038/cmj.v53i3.248

Cited by 10 publications

(11 citation statements)

References 14 publications

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“…The data also revealed a sharp shift over time toward admissions for paracetamol overdoses, a shift that has been noted by other researchers as well (13).…”

Section: Discussionsupporting

confidence: 80%

Deliberate self-harm in adolescents in Southern Sri Lanka; a hospital based Study

Senadheera

Marecek

2018

Galle Med J

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Introduction: Little is known about adolescents who engage in deliberate self-harm (DSH). Therefore, using data from medical and police records of the Teaching Hospital Karapitiya, we examined patterns of DSH among young people. Methods: We examined records of episodes of DSH for 2001 and for the 5 year period from 2006 through 2010. Data on 1720 individuals between 10 and 18 years old were gathered. Results: There was a striking increase from 2001 to 2010 in admissions of young people with DSH. In 2001, there were 137 cases; in 2010, the number had nearly tripled (N=391). Case fatality rates were low; in 2001, it was 8%; in 2010, it was 0.25%. Comparing 2001 to 2010, cases involving poisons decreased from 58% to 46%; cases involving medicinal overdoses increased from 41% to 54%. Adolescents rarely used other methods. In 2001 and in each year from 2006 to 2010, adolescents aged 15-18 years accounted for at least 85% of the sample, and there were three times more girls than boys. Conclusion: Decreases in suicides have been substantial; nonetheless, rates of non-fatal DSH have climbed. We call for research on antecedents and correlates of DSH in groups at high risk, such as older adolescent girls.

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“…The data also revealed a sharp shift over time toward admissions for paracetamol overdoses, a shift that has been noted by other researchers as well (13).…”

Section: Discussionsupporting

confidence: 80%

Deliberate self-harm in adolescents in Southern Sri Lanka; a hospital based Study

Senadheera

Marecek

2018

Galle Med J

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“…[1] A similar marked increase has also been noted over the same period in North Central Province hospitals. [1]…”

Section: Introductionsupporting

confidence: 56%

A quick inexpensive laboratory method in acute paracetamol poisoning could improve risk assessment, management and resource utilization

et al. 2012

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Objectives:Acute paracetamol poisoning is an emerging problem in Sri Lanka. Management guidelines recommend ingested dose and serum paracetamol concentrations to assess the risk. Our aim was to determine the usefulness of the patient's history of an ingested dose of >150 mg/kg and paracetamol concentration obtained by a simple colorimetric method to assess risk in patients with acute paracetamol poisoning.Materials and Methods:Serum paracetamol concentrations were determined in 100 patients with a history of paracetamol overdose using High Performance Liquid Chromatography (HPLC); (reference method). The results were compared to those obtained with a colorimetric method. The utility of risk assessment by reported dose ingested and colorimetric analysis were compared.Results:The area under the receiver operating characteristic curve for the history of ingested dose was 0.578 and there was no dose cut-off providing useful risk categorization. Both analytical methods had less than 5% intra- and inter-batch variation and were accurate on spiked samples. The time from blood collection to result was six times faster and ten times cheaper for colorimetry (30 minutes, US$2) than for HPLC (180 minutes, US$20). The correlation coefficient between the paracetamol levels by the two methods was 0.85. The agreement on clinical risk categorization on the standard nomogram was also good (Kappa = 0.62, sensitivity 81%, specificity 89%).Conclusions:History of dose ingested alone greatly over-estimated the number of patients who need antidotes and it was a poor predictor of risk. Paracetamol concentrations by colorimetry are rapid and inexpensive. The use of these would greatly improve the assessment of risk and greatly reduce unnecessary expenditure on antidotes.

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“…However our prospective case series didn't identify such incidences even though 55 patients received methionine compared 68 of IV NAC. Two patients received both antidotes owing to unavailability of IV NAC at the time of patient admission [3]. …”

Section: Discussionmentioning

confidence: 99%

“…Poisoning with paracetamol is an emerging problem in Sri Lanka with rapidly increasing admissions to the National Hospital of Sri Lanka (NHSL): from only 35 cases in 2003 to 515 cases in 2005 [3]. Paracetamol poisoning is one of the most expensive poisonings management in Sri Lanka [4,5].…”

Section: Introductionmentioning

confidence: 99%

A cost effectiveness analysis of the preferred antidotes for acute paracetamol poisoning patients in Sri Lanka

et al. 2012

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BackgroundAcute paracetamol poisoning is a rapidly increasing problem in Sri Lanka. The antidotes are expensive and yet no health economic evaluation has been done on the therapy for acute paracetamol poisoning in the developing world. The aim of this study is to determine the cost effectiveness of using N-acetylcysteine over methionine in the management of acute paracetamol poisoning in Sri Lanka.MethodsEconomic analysis was applied using public healthcare system payer perspective.Costs were obtained from a series of patients admitted to the National Hospital of Sri Lanka with a history of acute paracetamol overdose. Evidence on effectiveness was obtained from a systematic review of the literature. Death due to hepatotoxicity was used as the primary outcome of interest. Analysis and development of decision tree models was done using Tree Age Pro 2008.ResultsAn affordable treatment threshold of Sri Lankan rupees 1,537,120/death prevented was set from the expected years of productive life gained and the average contribution to GDP. A cost-minimisation analysis was appropriate for patients presenting within 10 hours and methionine was the least costly antidote. For patients presenting 10-24 hours after poisoning, n-acetylcysteine was more effective and the incremental cost effectiveness ratio of Sri Lankan rupees 316,182/life saved was well under the threshold. One-way and multi-way sensitivity analysis also supported methionine for patients treated within 10 hours and n-acetylcysteine for patients treated within 10-24 hours as preferred antidotes.ConclusionsPost ingestion time is an important determinant of preferred antidotal therapy for acute paracetamol poisoning patients in Sri Lanka. Using n-acetylcysteine in all patients is not cost effective. On economic grounds, methionine should become the preferred antidote for Sri Lankan patients treated within 10 hours of the acute ingestion and n-acetylcysteine should continue to be given to patients treated within 10-24 hours.

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Management of acute paracetamol poisoning in a tertiary care hospital

Cited by 10 publications

References 14 publications

Deliberate self-harm in adolescents in Southern Sri Lanka; a hospital based Study

Deliberate self-harm in adolescents in Southern Sri Lanka; a hospital based Study

A quick inexpensive laboratory method in acute paracetamol poisoning could improve risk assessment, management and resource utilization

A cost effectiveness analysis of the preferred antidotes for acute paracetamol poisoning patients in Sri Lanka

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