Pattern of Paracetamol Poisoning: Influence on Outcome and Complications

Castanares-Zapatero, Diego; Dinant, Valérie; Ruggiano, Ilaria; Willem, Harold; Laterre, Pierre‐François; Hantson, Philippe

doi:10.3390/toxics6040058

Cited by 13 publications

(13 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In fact, the causes of death were ethylene glycol, salicylates, beta‐blockers, metformin overdose, and carbon monoxide inhalation, which could be associated to a low oxygen concentration in cells. Besides, these findings are consistent with other studies where the correlation between hyperlactatemia, early mortality, and certain toxics was reported 31‐33 …”

Section: Discussionsupporting

confidence: 93%

“…Besides, these findings are consistent with other studies where the correlation between hyperlactatemia, early mortality, and certain toxics was reported. [31][32][33] Patients within the respiratory group presented an already bad baseline situation, which means that they must continually correct their hypoxemic state, disrupting the buffer systems that balance tissue perfusion 34,35 and making the pLA changes. On the contrary, in neurological pathologies (eg a sudden attack or stroke), the effects are exclusively local as compared to the other pathologies where these effects are systemic; this could explain why the pLA levels did not presented a relevant alteration at the time of EMS assistance.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Accuracy of prehospital point‐of‐care lactate in early in‐hospital mortality

Martin-Rodríguez

López-Izquierdo

Medina-Lozano

et al. 2020

Eur J Clin Investigation

View full text Add to dashboard Cite

Background: Emergency medical services (EMS) routinely face complex scenarios where decisions should be taken with limited clinical information. The development of fast, reliable and easy to perform warning biomarkers could help in such decisionmaking processes. The present study aims at characterizing the validity of point-ofcare lactate (pLA) during prehospital tasks for predicting in-hospital mortality within two days after the EMS assistance. Materials and methods: Prospective, multicentric, ambulance-based and controlled observational study without intervention, including six advanced life support and five hospitals. The pLA levels were recorded during EMS assistance of adult patients. The validity of pLA to determine the in-hospital mortality was assessed by the area under the curve (AUC) of the receiver operating curve (ROC). Results: A total of 2997 patients were considered in the study, with a median of 69 years (IQR 54-81) and 41.4% of women. The median pLA value was 2.7 mmol/L (1.9-3.8) in survivors and 5.7 mmol/L (4.4-7.6) in nonsurvivors. The global discrimination level of pLA reached an AUC of 0.867, being 1.9 mmol/L and 4 mmol/L the cutoff point for low and high mortality. The discrimination value of pLA was not affected by sex, age or pathology. Conclusions: Our results highlight the clinical importance of prehospital pLA to determine the in-hospital risk of mortality. The incorporation of pLA into the EMS protocols could improve the early identification of risky patients, leading to a better care of such patients. K E Y W O R D S clinical clerkship, critical care, emergency medical services, lactate, point-of-care testing 2 of 10 | MARTÍN-RODRÍGUEZ ET Al.

show abstract

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Accuracy of prehospital point‐of‐care lactate in early in‐hospital mortality

Martin-Rodríguez

López-Izquierdo

Medina-Lozano

et al. 2020

Eur J Clin Investigation

View full text Add to dashboard Cite

show abstract

“…It is defined by the presence of hepatic encephalopathy, jaundice, and coagulopathy in individuals without any history of cirrhosis occurring for less than 26 weeks [11]. The main reasons behind fulminant hepatic failure and death following acetaminophen intoxication are delay in seeking medical attention, delay in recognition of poison or delay in institution of appropriate therapy, and the existence of preexisting comorbidities [3,4]. The key to diagnosing fulminant hepatic failure, in this case, was the presence of deep icterus, hepatic encephalopathy characterized by flapping tremors, coagulopathy characterized by high INR, and low blood pressure.…”

Section: Discussionmentioning

confidence: 99%

“…In cases of multiple ingestions or when there is a delay in presentation, the prognosis is poor. Those patients may require intensive care management and anticipate the possibility of liver transplantation [3]. Though the mainstay of treatment in acetaminophen intoxication is…”

Section: Introductionmentioning

confidence: 99%

Acetaminophen Intoxication with Fulminant Hepatic Failure Salvaged by Plasmapheresis

Karunathilake¹,

Ranasinghe²,

Azher³

et al. 2021

IJCCR

View full text Add to dashboard Cite

Introduction Acetaminophen-induced liver injury is the most common cause of acute liver failure, where multiple ingestions or a delay in the presentation may lead to a poor prognosis. N-acetylcysteine (NAC) is the conventional antidote used to treat acute acetaminophen toxicity, and plasmapheresis can be used as an adjunct, though there are no systematic studies to prove its effectivity. Case Presentation An 18-year-old girl was admitted with reduced responsiveness for one day with a few episodes of diarrhea. On admission, she was febrile and had a GCS of 10/15, otherwise normal neurology. She had marked right hypochodrial tenderness, deep icterus, and a pulse of 120 beats per minute, with a blood pressure of 80/50 mmHg; fluid resuscitation with inotropic support was done. Initial investigations revealed severe metabolic acidosis, hemoglobin of 9.5 g/dL, white blood cell count 13,500/mm3, and platelet 119,000 per µL. The prothrombin time (PT) international normalized ratio (INR) was 4.7, and the activated partial thromboplastin time (APTT) was 38.6. The alanine aminotransferase (ALT) level was 8118 U/L, and aspartate aminotransferase (AST) was 3883 U/L with a total bilirubin of 107 µmol/L. The diagnosis of acute liver failure following acetaminophen intoxication was made and managed with intravenous NAC, pantoprazole cover, intravenous ceftriaxone, metronidazole, thiamine, and vitamin K. Fresh frozen plasma and platelets were given for severe coagulopathy. She was started with plasmapheresis at the intensive care unit (ICU), where she had a significant improvement, though she developed hospital-acquired pneumonia, which was successfully managed. Subsequently, her liver functions returned to the baseline, and she was discharged after a psychiatric assessment. Conclusion A high degree of suspicion needs to be adopted to diagnose acetaminophen-induced acute liver failure when a patient presents with hepatic encephalopathy, and plasmapheresis can be considered a life-saving measure adjunct to the NAC.

show abstract

“…This treatment is administered based on the Rumack-Matthew nomogram [ 5 , 6 ], which plots plasma paracetamol levels against the time since ingestion. Despite a widely available antidote therapy (NAC) and recognition of numerous risk factors, which have been discussed in the literature [ 7 , 8 , 9 , 10 ], acetaminophen-induced hepatotoxicity still occurs.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Hepatotoxicity Due to Paracetamol Overdose in Adults

et al. 2021

View full text Add to dashboard Cite

Background and Objectives: Over-the-counter availability and a good safety profile make paracetamol one of the most common analgesics in developed countries but also the leading cause of liver failure due to overdose. The objectives of the study were to identify modifiable risk factors for severe hepatotoxicity following paracetamol overdose in adults. Materials and Methods: A retrospective cohort study involved the consecutive adult patients hospitalized in a toxicological center over a period of seven years due to paracetamol overdose. Complete medical datasets of laboratory and anamnestic variables were analyzed and validated by means of logistic regression model. Results: A total of 185 patients entered the study, including 25 individuals who developed severe hepatotoxicity (plasma aminotransferases levels above 1000 UI/L) and 31 individuals with mild to moderate liver injury (plasma aminotransferases levels above upper normal range, but below 1000 UI/L). In the univariable analysis, significant hepatotoxicity risk factors were male gender, alcohol abuse, an ingested paracetamol dose, and a timespan from ingestion to hospital admission. The later one was the only significant risk factor in the multivariable model (adjusted odds ratio 1.08; 95% CI: 1.03–1.12). Conclusions: A delay in hospital admission, resulting in a delayed administration of disease-specific treatment outweighs any other known risk factors of paracetamol-induced hepatotoxicity.

show abstract

Pattern of Paracetamol Poisoning: Influence on Outcome and Complications

Cited by 13 publications

References 32 publications

Accuracy of prehospital point‐of‐care lactate in early in‐hospital mortality

Accuracy of prehospital point‐of‐care lactate in early in‐hospital mortality

Acetaminophen Intoxication with Fulminant Hepatic Failure Salvaged by Plasmapheresis

Risk Factors for Hepatotoxicity Due to Paracetamol Overdose in Adults

Contact Info

Product

Resources

About