GUIDELINES FOR PARACETAMOL POISONING TREATMENT
Abstract
Paracetamol overdose results in an accumulation of the reactive, hepatotoxic metabolite N-acetyl-p-benzoquinoneimin (NAPKQI) which can cause serious liver injury. Recognition of paracetamol overdose, hepatotoxicity risk estimation and early treatment are crutial in paracetamol poisoniong management. In ingestion of potential hepatotoxic dose of paracetamol decontamination and early treatment with N-acetylcysteine (NAC) are indicated. Both, 20-hours intravenous and 72-hurs oral regimes of NAC administration are successful. By antidote regime selection we should consider patient condition and time after paracetamol overdose. In severe hepatotoxicity, criteria for liver transplantation should be regularly evaluated and mechanisms for liver transplantation must be activated in time.
Downloads
References
Prescott LF, Illingworth RN, Critchley JAJH, Stewart MJ, Adam RD, Proudfoot AT. Intravenous N-acetylcysteine: the treatment of choice for paracetamol (acetaminophen) poisoning. BMJ 1979; 2:1097-100.
Koch-Weser J. Acetaminophen. N Engl J Med 1976; 295:1297-1300.
Heard K. Acetylcystenine for acetaminophen poisoning. New Engl J Med 2008; 359:285.
Gunnell D, Murray B, Hawton K. Use of paracetamol (acetaminophen) for suicide and nonfatal poisoning: worldwide patterns of use and misuse. Suicide Life Threat Behav 2000; 30:313-26.
Goldfrank LR, Flomenbaum NE, Lewin NA et al, eds. Goldfrank's Toxicologic Emergencies, 9th ed. New York: McGraw-Hill; 2011.
Tsang WO, Nadroo AM. An unusual case of acetaminophen overdose. Ped Emerg Care 1999; 15:344-6.
Olson K. Poisoning and drug overdose. 6th ed. New York: McGraw-Hill; 2012.
Gray T, Hoffman RS, Bateman DN. Intravenous paracetamol--an international perspective of toxicity. Clin Toxicol (Phila). 2011 Mar;49(3):150-2.
Clements JA, Prescott LF. Data point weighting in pharmacokinetic analysis: intravenous paracetamol in man. J Pharm Pharmacol 1976; 28:707-9.
Shah AD, Wood DM, Dargan PI. Understanding lactic acidosis in paracetamol (acetaminophen) poisoning. Br J Clin Phamacol 2010; 71:20-8.
Dart RC, Erdman AR, Olson KR, Christianson G, Manoguerra AS, Chyka PA et al. Acetaminophen poisoning: an Evidence-Based Consensus Guideline for Out-of-Hospital Management. Clinical Toxicology 2006; 44:1-18.
Rumack BH, Matthew H. Acetaminophen poisoning and toxicity. Pediatrics 1975; 55(6): 871-6.
Rumack BH, Bateman ND. Acetaminophen and acetylcysteine dose and duration: Past, present and future. Clin Toxicol 2012; 50: 91-8.
Buckley NA, Whyte IM, O'Connell DL, et.al. Oral or intravenous N-acetylcysteine: which is the treatment of choice for acetaminophen (paracetamol) poisoning? J Toxicol Clin Toxicol 1999; 37(6): 759-67.
Prescott L. Oral or intravenous N-acetylcysteine for acetaminophen poisoning? Ann Emerg Med 2005; 45(4): 409-13.
Smilkstein MJ, Bronstein AC, Linden C, et.al. Acetaminophen overdose: a 48 hour intravenous N-acetylcysteine treatment protocol. Ann Emerg Med 1991; 20 (10):1058-63.
Kerr F, Dawson A, Whyte IM, Buckley N, Murray L, Graudins A, Chan B, Trudinger B. The Australasian clinical toxicology investigators collaboration randomised trial of different loading infusion rates of N-acetylcysteine. Ann Emerg Med. 2005; 54:402-8.
Mant TGK, Tempowski JH, Volans GN, Talbot JCC. Adverse reactions to acetylcysteine and effects of overdose. BMJ 1984; 289:217-9.
Chan TYK, Critchley JAJH. Adverse reactions to intravenous N-acetylcysteine in Chinese patients with paracetamol (acetaminophen) poisoning. Hum Exp Toxicol 1994; 13:542-4.
Bailey B, McGuigan MA. Management of anaphylactoid reactions to intravenous N-acetylcysteine. Ann Emerg Med 1998: 31:710-5.
Sandilands EA, Bateman DN. Adverse reactions associated with acetylcysteine. Clin Toxicol 2009; 47:81-8.
Donovan JW, Gorayeb MJ, Kulig KW. Adverse reactions to slow infusion of intravenous N-acetylcysteine (abstract). Vet Hum Toxicol 1990; 32:347.
Prescott LF, Donovan JW, Jarvie DR, Proudfoot AT. The disposition and kinetics of intravenous N-acetylcysteine in patients with paracetamol overdosage. Eur J Clin Pharmacol 1989; 37:501-16.
Larrey D, Pageaux GP. Drug-induced acute liver failure. Eur J Gastroenterol Hepatol 2005; 17 (2): 141-3.
Bailey B, Amre DK, Gaudreault P. Fulminant hepatic failure secondary to acetaminophen poisoning: a systematic review and meta-analysis of prognostic criteria determining the need for liver transplantation. Crit Care Med. 2003; 31(1):299-305.
Prescott LF, Newton RW, Swainson CP, Wright N, Forrest AR, Matthew H. Successful treatment of severe paracetamol overdosage with cysteamine. Lancet 1974; 1:588-92.
Matthew H. Acute acetaminophen poisoning. Clin Toxicol 1973; 6:9-11.
Piperno E, Berssenbruegge DA. Reversal of experimental paracetamol toxicosis with N-acetylcystamine. Lancet 1976; 2:738-9.
Piperno E, Mosher AH, Berssenbruegge DA, Winkler JD, Smith RD. Patophysiology of acetaminophen overdosage toxicity: implications for management. Pediatrics 1978; 62:880-9.
Harrison PM, Keays R, Bray GP, Alexander GJ, Williams R. Improoved outcome of paracetamol-induced fulminant hepatic failure by late administration of acetylcysteine. Lancet 1990; 335: 1572-3.
Parker D, White JP, Paton D, Routledge PA. Safety of late acetylcysteine treatment in paracetamol poisoning. Hum Exp Toxicol 1990; 9:25-7.
Keays R, Harrison PM, Wendon JA, Forbes A, Gove C, Alexander GJ, Williams R. Intravenous acetylcysteine in paracetamol induced fulminant hepatic failure: a prospective controlled trial. BMJ 1991; 303:1026-9.
Knight TR, Ho SY, Farhood A, et.al. Peroxynitrite is a critical mediator of acetaminophen hepatotoxicity in murine livers: protection by glutathione. J Pharmacol Exp Ther 2002; 303(2):468-75.
Saito C, Zwingmann C, Jaeschke H. Novel mechanisms of protection against acetaminophen hepatotoxicity in mice by glutathione and N-acetylcysteine. Hepatology 2010; 51(1):246-54.
Boyland E, Chasseaud LF. The role of glutathione and glutathione S-transferases in mercapturic acid biosynthesis. Adv Enzymol Relat Areas Mol Biol 1969; 32:173-219.
Yang R, Miki K, He X, Killeen ME, Fink MP. Prolonged treatment with N-acetylcysteine delays liver recovery from acetaminophen hepatotoxicity. Crit Care 2009; 13:R55.
Keays R, Harrison PM, Wendon JA, Forbes A, Gove C, Alexander GJ, Williams R. Intravenous acetylcysteine in paracetamol induced fulminant hepatic failure: a prospective controlled trial. BMJ 1991; 303:1026-9.
Yip L, Dart RC, Hurlbut KM. Intravenous administration of oral N-acetylcysteine. Crit Care Med 1998; 26: 40-3.
Lauterburg BH, Mitchell JR. Regulation of hepatic glutathione turnover in rats in vivo and evidence for kinetic homogeneity of the hepatic glutathione pool. J Clin Invest 1981; 67: 1415-24.
Yarema MC, Johnson DW, Berlin RJ, Sivilotti ML, Nettel-Aguirre A, Brant RF et.al. Comparison of the 20-hour intravenous and 72-hour oral acetylcysteine protocols for the treatment of acute acetaminophen poisoning. Ann Emerg Med 2009; 54:606-14.
Spiller HA, Sawyer TS. Impact of activated charcoal after acute acetaminophen overdoses treated with N-acetylcysteine. J Emerg Med 2007; 33(2):141-4.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
