Vomiting in paracetamol poisoning.

Adams, R H; Dallos, V; Daniels, Richard; Helps, P J; Rogers, Nancy; Guest, K P; Rose, David J.; Wiseman, Hannah

doi:10.1136/bmj.280.6213.560-c

Cited by 3 publications

(1 citation statement)

References 2 publications

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“…In a study by Rumack, vomiting occurred in 33.3% of 662 patients with an acetaminophen overdose [21]. Another study in the United Kingdom showed that the prevalence of vomiting among 392 patients with acetaminophen overdose, of whom 120 took acetaminophen alone, was 11.7% [24]. Because the UK study did not report the incidence of vomiting in the acetaminophen alone group and could not exclude the confounding influence of co‐ingestants (e.g.…”

Section: Discussionmentioning

confidence: 99%

Assessing the Impact of Vomiting Episodes on Outcome after Acetaminophen Poisoning

Zyoud

Awang

Sulaiman

et al. 2010

Basic Clin Pharma Tox

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Identifying indices of poor prognosis at first presentation after acetaminophen poisoning is the key to both improving clinical care and determining targets for intervention. This study intended to document the prevalence, clinical characteristics and predictors of vomiting and to investigate the relationship between episodes of vomiting at first hospital presentation and outcome in acetaminophen poisoning. This retrospective cohort study included patients who attended the emergency department and were admitted within 24 hr of acetaminophen ingestion. The study was conducted over a period of 5 years from 1 January 2004 to 31 December 2008. Parametric and non-parametric tests were used to test differences between groups depending on the normality of the data. SPSS 15 was used for data analysis. Data from 291 patients were included. Vomiting was present in 65.3% of patients with acetaminophen poisoning at the time of first presentation. Multiple logistic regression showed that significant risk factors for vomiting were present among patients who reported an ingested dose of acetaminophen ‡10 g (p < 0.001) and a latency time of more than 8 hr (p = 0.030). Overall, an increasing trend in prothrombin time (p = 0.03), serum bilirubin (p < 0.001), serum creatinine (p = 0.005), serum potassium (p < 0.001), length of hospital stay (p < 0.001) and the prevalence of patients who had a serum acetaminophen level above a 'possible toxicity' treatment line (p = 0.001) were associated with an increased number of episodes of vomiting. In conclusion, vomiting was common among patients with acetaminophen poisoning. This study suggests that an increase in episodes of vomiting at first presentation appears to be an important risk marker of subsequent nephrotoxicity and hepatotoxicity.

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Section: Discussionmentioning

confidence: 99%

Assessing the Impact of Vomiting Episodes on Outcome after Acetaminophen Poisoning

Zyoud

Awang

Sulaiman

et al. 2010

Basic Clin Pharma Tox

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Vomiting in paracetamol overdose

Herren

2002

Emergency Medicine Journal

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A short cut review was carried out to establish whether there was any evidence to decide between oral or intravenous antidote in paracetamol (acetaminophen) poisoning. Altogether 330 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated. Clinical scenarioA 23 year old woman attends an emergency department having taken sixty 500 mg paracetamol tablets. Her four hour paracetamol levels are above the treatment line. She does not want to be treated with intravenous therapy. You wonder whether oral antidote is as effective. Search outcomeAltogether 330 papers were identified, of which two were directly relevant to the question (table 1). Comment(s)Perry's study used historical controls although the demographic characteristics of the two groups were remarkably similar. It was not included in Buckley's meta-analysis because the patients were not recruited sequentially and it was unclear whether the patients were treated solely at the study centre (possible variations in other treatment modalities could act as confounding factors).There have been no RCTs in this area. A meta-analysis of observational studies has failed to show a difference in efficacy between the oral and intravenous routes. However, these studies do not address other factors that may influence the choice of route, which include: activated charcoal adsorbs antidote and therefore precludes its use; the IV regimen is shorter than the oral (24 hours and 52 hours respectively); the IV route is safer with patients with altered levels of consciousness (for example due to coingestants) who may subsequently lose their airway protective reflexes.c CLINICAL BOTTOM LINE The IV route is the treatment of choice for paracetamol poisoning, but the oral route has a similar efficacy and is a suitable alternative if IV access is difficult (for example IV drug abusers) or refused by the patient. Best evidence topic reports (BETs) summarise the evidence pertaining to particular clinical questions. They are not systematic reviews, but rather contain the best (highest level) evidence that can be practically obtained by busy practising clinicians. The search strategies used to find the best evidence are reported in detail in order to allow clinicians to update searches whenever necessary. The BETs published below were first reported at the Critical Appraisal Journal Club at the Manchester Royal Infirmary. 1 Each BET has been constructed in the four stages that have been described elsewhere.2 The BETs shown here together with those published previously and those currently under construction can be seen at http://www.bestbets.org.3 Six BETs are included in this issue of the journal.

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Analgesic Poisoning: a Multi-centre, Prospective Survey

1981

Human Toxicology

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Vomiting in paracetamol poisoning.

Cited by 3 publications

References 2 publications

Assessing the Impact of Vomiting Episodes on Outcome after Acetaminophen Poisoning

Assessing the Impact of Vomiting Episodes on Outcome after Acetaminophen Poisoning

Vomiting in paracetamol overdose

Analgesic Poisoning: a Multi-centre, Prospective Survey

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