Puzzling Situation of Acetaminophen Toxicity in a Referral Hospital, Tehran, Iran Acetaminophen toxicity in a referral hospital
Iranian Journal of Pharmaceutical Sciences,
Vol. 14 No. 2 (2018),
1 April 2018
,
Page 93-102
https://doi.org/10.22037/ijps.v14.40666
Abstract
Acetaminophen carries a higher risk of overdose. A puzzling situation of acetaminophen toxicity was encouraging enough to explore the epidemiologic situation of acetaminophen toxicity and its outcomes among patients acquired poisoning. This cross-sectional study retrospectively reviewed the medical records of 185 patients with acetaminophen poisoning referred to Loghman Hakim Hospital. Toxicity determined by acetaminophen serum concentration and time elapsed after drug ingestion. Demographics, laboratory markers, toxic hepatitis, renal failures, and liver enzyme elevations were compared between toxic and non-toxic patients. Twelve cases belonged to the former group and 173 patients fitted with the latter one. Having a mean age of 24.27±7.19 and 21.58±3.47 years, respectively, females were predominant. The average serum acetaminophen level was 70.37±61.92 and 24.90±26.36 within toxic and nontoxic patients, respectively. Median of consumed tablets were estimated as 40 for non-toxic and 18 for toxic patients (p=0.017). Mean hospital stay was 1.75±1.05 days for toxic patients and 1.35±3.25 days for the non-toxic group (p-value<0.001), and of whom 92.4 % were discharged within the first day. The laboratory assessments revealed no significant difference between groups. No death was recorded. Whereas hepatotoxicity was present in three toxic patients, renal failure was predominant in non-toxic patients. Rarely, a rise in liver enzyme was noticed; however, 33.33 % of toxic and 2.31 % of the non-toxic group had elevated AST; and 33.33 % of toxic versus 1.73 % percent of non-toxic patients had increased ALT. Acetaminophen toxicity is a worldwide noteworthy cause of poisoning which has distinct mortality and morbidity rates and showed an amazing and undebatable poisoning effect in the present study. A comprehensive study is required to examine the possible reasons for the difference between Iranian acetaminophen products with other non-Iranian company products.
- Acetaminophen
- Hepatotoxicity
- Poisoning
- Renal failure
- Toxicity
How to Cite
References
[2] Hou YC, Lin JL, Huang WH, Weng CH, Lee SY, Hsu CW, Wang IK, Liang CC, Chang CT, Lin WR, Yen TH. Outcomes of patients with acetaminophen-associated toxic hepatitis at a far east poison center. Springerplus (2013) 2:674 DOI: 10.1186/2193-1801-2-674.
[3] Quallich LG, Brown JW, Shehab TM, Fontana RJ. Management of acetaminophen hepatotoxicity: A survey of practicing physicians. JCOM( 2001) 8(6):25-32.
[4] Rumack BH, Matthew H. Acetaminophen poisoning and toxicity. Pediatrics (1975) 55(6):871-6.
[5] Buckley N, Eddleston M. Paracetamol (acetaminophen) poisoning. Clin Evid (2005)(14):1738-44.
[6] Alaniz C, Janusz J. A retrospective study of the etiologies and outcomes of patients admitted to a university hospital with presumed acetaminophen toxicity. Hosp Pharm (2007) 42(2):126-32.
[7] Noshad H, Sadreddini S, Etemadi J. Acetaminophen self-poisoning: Suicidal and accidental. Iranian Journal of Psychiatry and Behavioral Sciences (2010) 4(1):47-52.
[8] Badsar A, Rahbar Taramsari M, Sotodeh Foumani N, Ebrahimi H, Fallah Karkan M. Demographic information and clinical and laboratory findings in acetaminophen poisoning cases in rasht, iran, in 2008. Iranian Journal of Toxicology( 2012) 6(18):681-5.
[9] Hendrickson RG. The clinical basis of medical toxicology, acetaminophen. Goldfrank's toxicologic emergencies. 1. New York: McGraw-Hill Medical (2011). p. 447-58.
[10] Ayonrinde OT, Phelps GJ, Hurley JC, Ayonrinde OA. Paracetamol overdose and hepatotoxicity at a regional australian hospital: A 4-year experience. Intern Med J (2005);35(11):655-60 DOI: 10.1111/j.1445-5994.2005.00947.x.
[11] Mcclain CJ, Price S, Barve S, Devalarja R, Shedlofsky S. Acetaminophen hepatotoxicity: An update. Curr Gastroenterol Rep( 1999)1(1):42-9.
[12] Vale JA, Proudfoot AT. Paracetamol (acetaminophen) poisoning. Lancet (1995) 346(8974):547-52.
[13] Weng CH, Hu CC, Lin JL, Lin-Tan DT, Huang WH, Hsu CW, Yen TH. Sequential organ failure assessment score can predict mortality in patients with paraquat intoxication. PLoS One (2012)7(12):e51743 DOI:10. 1371/journal.pone. 0051743.
[14] Yang CJ, Lin JL, Lin-Tan DT, Weng CH, Hsu CW, Lee SY, Lee SH, Chang CM, Lin WR, Yen TH. Spectrum of toxic hepatitis following intentional paraquat ingestion: Analysis of 187 cases. Liver Int (2012);32(9):1400-6 DOI: 10.1111/j.1478-3231.2012.02829.x.
[15] Lee WM. Acetaminophen-related acute liver failure in the united states. Hepatol Res (2008);38 Suppl 1:S3-8 DOI: 10.1111/j.1872-034X.2008.00419.x.
[16] Schiodt FV, Rochling FA, Casey DL, Lee WM. Acetaminophen toxicity in an urban county hospital. N Engl J Med ( 1997) 337(16):1112-7 DOI: 10.1056/NEJM199710163371602.
[17] Larson AM, Polson J, Fontana RJ, Davern TJ, Lalani E, Hynan LS, Reisch JS, Schiodt FV, Ostapowicz G, Shakil AO, Lee WM, Acute Liver Failure Study G. Acetaminophen-induced acute liver failure: Results of a united states multicenter, prospective study. Hepatology (2005) 42(6):1364-72 DOI: 10.1002/hep.20948.
[18] Smilkstein MJ, Knapp GL, Kulig KW, Rumack BH. Efficacy of oral n-acetylcysteine in the treatment of acetaminophen overdose. Analysis of the national multicenter study (1976 to 1985). N Engl J Med (1988) 319(24):1557-62 DOI: 10.1056/NEJM198812153192401.
[19] Temple A, Baggish J. Guidelines for the management of acetaminophen overdose. McNeil consumer and speciality pharmaceuticals (2005).
[20] Chan TY, Chan AY, Critchley JA. Factors responsible for continuing morbidity after paracetamol poisoning in chinese patients in hong kong. Singapore Med J (1996) 37(3):275-7.
[21] Le Vaillant J, Pellerin L, Brouard J, Eckart P. [acetaminophen (paracetamol) causing renal failure: Report on 3 pediatric cases]. Arch Pediatr (2013) 20(6):650-3 DOI: 10.1016/j.arcped.2013.03.027.
[22] Jones AL, Prescott LF. Unusual complications of paracetamol poisoning. QJM (1997);90(3):161-8.
[23] Waring WS, Jamie H, Leggett GE. Delayed onset of acute renal failure after significant paracetamol overdose: A case series. Hum Exp Toxicol (2010) 29(1):63-8 DOI: 10.1177/0960327109350799.
[24] Talaie H, Pajouhmand A, Abdollahi M, Panahandeh R, Emami H, Hajinasrolah S, Tghaddosinezhad M. Rhabdomyolysis among acute human poisoning cases. Hum Exp Toxicol (2007) 26(7):557-61 DOI: 10.1177/0960327107078667.
[25] Amacher DE. Female gender as a susceptibility factor for drug-induced liver injury. Hum Exp Toxicol (2014) 33(9):928-39 DOI: 10.1177/0960327113512860.
[26] Kjartansdottir I, Bergmann OM, Arnadottir RS, Bjornsson ES. Paracetamol intoxications: A retrospective population-based study in iceland. Scand J Gastroenterol (2012) 47(11):1344-52 DOI: 10.3109/00365521.2012.703236.
[27] Miners JO, Attwood J, Birkett DJ. Influence of sex and oral contraceptive steroids on paracetamol metabolism. Br J Clin Pharmacol (1983) 16(5):503-9.
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