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Acute liver failure
Published in Louisa Baxter, Neel Sharma, Ian Mann, The Junior Doctor’s Guide to Gastroenterology, 2018
Louisa Baxter, Neel Sharma, Ian Mann, Ian Sanderson
The British National Formulary (BNF) and most Accident and Emergency departments will have a treatment threshold in the paracetamol poisoning monograph. This triages patients into high and normal risk. Treat patients with chronic alcohol abuse, chronic malnutrition or recent starvation, HIV/AIDS or patients on hepatic enzyme inducers (phenytoin, carbamazepine, barbituates, rifampicin, alcohol, sulphonylureas) as high risk.
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Published in Caroline Ashley, Aileen Dunleavy, John Cunningham, The Renal Drug Handbook, 2018
Caroline Ashley, Aileen Dunleavy, John Cunningham
Bennett recommends administering 75% of dose for patients with severe renal impairment; however, the manufacturer does not recommend a dose reduction for paracetamol poisoning and, from its records, neither does the National Poisons Centre.
Two serious prescribing pitfalls caused by alcohol use (and abuse)
Published in Hugh Mcgavock, Pitfalls in Prescribing and How to Avoid Them, 2017
In particular, beware paracetamol overdose in chronic drinkers. Because of enzyme induction, their livers produce more of the toxic paracetamol metabolite N-acetyl-p-benzoquinone imine (NAPBQI), which is the common cause of death in paracetamol poisoning. Alcoholics and heavy drinkers should be warned to avoid paracetamol.
Performance of the paracetamol-aminotransferase multiplication product in risk stratification after paracetamol (acetaminophen) poisoning: a systematic review and meta-analysis
Published in Clinical Toxicology, 2023
Chun En Yau, Haoyang Chen, Bryant Po-Yuen Lim, Mingwei Ng, R. Ponampalam, Daniel Yan Zheng Lim, Yip Han Chin, Andrew Fu Wah Ho
This meta-analysis is the first to aggregate the data of all known studies about the paracetamol × AT multiplication product. The results provide information about the prognostic performance of the two well-established cut-off values of 1500 mg/L × IU/L and 10,000 mg/L × IU/L and provides a comprehensive overview of possible subgroups. It also presents optimal cut-off values for paracetamol × AT in different clinical scenarios where the nomogram cannot be used. Although there were no deaths or cases of acute liver failure reported in this study, this could be due to insufficient follow up time. There are reports of mortality and liver transplant in patients who have survived paracetamol poisoning in the longer term [41]. Using paracetamol × AT can help to identify more patients to undergo acetylcysteine treatment, which might hence have longer term benefits. Paracetamol × AT also accounts for many factors such as the time of ingestion, quantity of ingestion, and severity of ingestion into a single continuously valued variable, thus recognising the spectrum of severity in paracetamol poisoning unlike the Rumack-Matthew nomogram which only indicates two categories: high-risk and low-risk. It should be noted that other existent risk stratification tools, such as the King’s College criteria [42], are used to predict patients with fulminant hepatic failure who will benefit from liver transplantation. In paracetamol-overdose patients, the multiplication product can be used at an early stage of treatment to adjust acetylcysteine dosage accordingly, possibly complementing the use of the King’s College criteria.
Paracetamol poisoning: a population-based study from Iceland
Published in Scandinavian Journal of Gastroenterology, 2021
Þorbjörg Andrea Friðriksdóttir, Freyja Jónsdóttir, Curtis P. Snook, Helena Líndal, Einar S. Björnsson
Paracetamol poisoning is a relatively common health problem and the most common cause of acute liver failure (ALF) in many European countries and the United States of America [1–3]. Within Europe, a vast difference has been observed between countries in the rate of paracetamol overdose leading to ALF; overall, paracetamol overdose accounted for one-sixth of all-cause ALF leading to registration for transplantation [3]. The wide availability of and easy access to paracetamol has made it one of the most common drugs ingested in overdose [4–6]. Paracetamol is safe and effective when ingested in therapeutic doses; however, hepatotoxicity can occur in an overdose [7]. N-acetylcysteine (NAC) is an effective antidote in treating paracetamol-induced hepatotoxicity [8]. Hepatotoxicity and/or nephrotoxicity are the well-recognized complications of overdose [9]. Paracetamol poisoning is usually related to a single overdose leading to acute poisoning, whereas accidental poisoning involving repeated doses has been associated with worse liver-related outcomes in many studies [8,10–14].
N-acetylcysteine suppresses colistimethate sodium-induced nephrotoxicity via activation of SOD2, eNOS, and MMP3 protein expressions
Published in Renal Failure, 2018
Bahadir Ceylan, Mehmet Ozansoy, Ülkan Kılıç, Yasemin Yozgat, Çilem Ercan, Pelin Yıldız, Turan Aslan
It is known that the dose of colistin given to rats intraperitoneally, which is 150 000 IU/kg/day, is the maximum therapeutic dose used for humans [8]. In previous studies that examine whether nephrotoxic effects of drugs such as vancomycin and gentamicin are prevented by NAC, it was seen that NAC was used at a dose of 10–200 mg/kg/day intraperitoneally and these doses could prevent histological renal damage [30–34,41]. In two studies performed previously, high doses of NAC such as 500 mg/kg/day were used [42,43]. In only one study that examined the effect of NAC on colistin-related nephrotoxicity, NAC was used at a dose of 150 mg/kg/day intraperitoneally [21]. Patients admitted to hospitals with paracetamol poisoning were treated with the recommended dose of 300 mg/kg/day of NAC [44]. Therefore, 300 mg/kg/day dose regimen of NAC was preferred in order to increase the effectiveness of NAC for the purposes of our study. In our study, NAC was administered intraperitoneally since a high level of elimination occurs during the first passage through the liver when administered orally.