Medical Fortune‐telling: Predicting Acetaminophen Toxicity

Donovan, J. Ward

doi:10.1111/j.1553-2712.1999.tb00106.x

Cited by 5 publications

(8 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…5 The relation of history of panic attacks to a patient's sex in our sample was strikingly similar to that reported for dysfunctional breathing 1 , with a significant excess in female patients of around 15% in both studies.…”

Section: Panic Disorder Needs To Be Consideredsupporting

confidence: 88%

“…4 McPherson represents a traditional view in the United Kingdom that is counterproductive to change. As Daly et al show in the accompanying paper, 5 there are too few intensive care beds in the NHS. Trials to prove the effectiveness of intensive care will not influence spending since a life lost on the ward costs less than one saved in intensive care.…”

Section: Research In Intensive Care Needs To Find Balance Between Scimentioning

confidence: 97%

“…The advantages of such stepdown care have been long and widely recognised. 5 Further consideration is also merited of the cause of death of patients after discharge from intensive care. Although this paper excluded discharges deemed "not for resuscitation," no numbers are given.…”

Section: Lettersmentioning

confidence: 99%

“…Large observational databases containing validated information from many thousands of patients provide an important alternative in this context and may well be more robust than meta-analyses in terms of the validity of their output. 5 A research method based on collaborative networks, observational databases to adjust for case mix, and agreed standards of care should form the basis for evaluating existing technologies, incorporating prospective randomised controlled trials where this is possible. As clinical researchers, we have a duty to find a balance between rigorous scientific method and the ethical problems associated with (in this instance) persuading patients or their relatives that they should be allocated to early discharge from intensive care to understaffed and overworked hospital wards.…”

Section: Research In Intensive Care Needs To Find Balance Between Scimentioning

confidence: 99%

“…Implementing key lessons from adverse events in the NHS is now a central component of government policy. 5 Replacement of anaesthetic machines without anti-hypoxia devices would be in the interests of patients, managers, and clinicians alike. …”

mentioning

confidence: 99%

See 4 more Smart Citations

Almost 30% of anaesthetic machines in UK do not have anti-hypoxia device

Saunders

Meek

2001

BMJ

View full text Add to dashboard Cite

Authors did not look at effects on all deliberate and accidental self poisoningEditor-Hawton et al provide some evidence of a decrease in the severity and incidence of paracetamol and salicylate poisonLetters 633 BMJ VOLUME 323 15 SEPTEMBER 2001 bmj.com ing after pack sizes of these drugs were restricted.1 They have not, however, considered the effect on deliberate self poisoning as a whole, or on self poisoning with other drugs.Limiting access to one type of drug may simply increase the incidence of overdose with other potentially more dangerous substances. It is important to determine if poisoning with other agents increases.2 Although the authors allude to this in their discussion, they mention only the small but significant increase in overdoses with paracetamol compounds and paracetamol with other drugs. Using self poisoning with paracetamol and salicylates alone as a measure of the effect of this legislation on self poisoning is erroneous and potentially dangerous.Hawton et al have not considered the effect of the legislation on accidental poisoning in children. This is a critical public health issue and needs to be evaluated alongside deliberate self poisoning to assess the impact of any change in legislation. Data from poison information centres would be useful to evaluate any changes in paediatric accidental poisoning.With only one year of data after the change of legislation available, it is of concern that the results are not significant for the larger liver transplant units alone. Furthermore, the biochemical data do not support the decrease in severity of cases, with no change in the mean highest blood paracetamol concentration. The slight decrease in mean highest prothrombin time is a poor measure of severity: about half of patients with paracetamol poisoning without hepatotoxicity will have a raised prothrombin time, 3 so it is a poor indicator of liver poisoning.We are concerned that the authors conclude that the legislation has been relatively successful without properly assessing its effects on all deliberate and accidental self poisoning. Geoff Isbister toxicology registrar Paracetamol should be packaged with its antidoteEditor-Paracetamol overdose is the most common cause of acute hepatic failure. Hepatocytes become sensitive to paracetamol metabolites and inflammatory mediators 1 when intracellular glutathione is depleted due to metabolism of paracetamol.2 For this reason, many clinical conditions associated with glutathione depletionfor example, chronic alcohol abuse, multiorgan system failure, chemotherapy, and certain metabolic diseases-place patients at risk of paracetamol toxicity, even at therapeutic doses of paracetamol. In addition, patients without predisposing disease are at risk because over the counter preparations often contain paracetamol and represent sources of potential overdose.Importantly, Hawton et al report that morbidity and mortality from paracetamol overdose decreased after legislation in the United Kingdom to restrict the package sizes of the drug.3 As the authors n...

show abstract

Section: Panic Disorder Needs To Be Consideredsupporting

confidence: 88%

Section: Research In Intensive Care Needs To Find Balance Between Scimentioning

confidence: 97%

Section: Lettersmentioning

confidence: 99%

Section: Research In Intensive Care Needs To Find Balance Between Scimentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations