Abstract
Aim: We aimed to evaluate the demographical and
clinical variations and treatment and complications of the patients admitted to
emergency department (ED) with paracetamol intoxication.
Material and Method: This is a retrospective
study. Patients who were diagnosed as paracetamol intoxication at the ED of
Keçiören Health Research and Application Center Hospital included into the
study. Patients with missed data, pregnant patients and patients with drug
intoxications other than paracetamol were excluded. Statistical analysis was
performed using the Statistical Package for the Social Sciences version 16.0. P-value less than 0.05 was considered
statistically significant.
Results:
Fifty-five patient included into the study.
Mean age of the patients was 34±12 years and 63.6% of them were female. The amount of paracetamol
ingested was 11.02±4.04
gr and fourth hour paracetamol level was 28.8 µg/dl (IQR 25-75: 12.5-41.7).
There was a statistically significant weak correlation between the amount of
paracetamol ingested and the blood paracetamol level of the patients(r=0,475
ve p=0,04). Liver function
tests of the patients were elevated during the follow up and that was
statistically significant (p<0.05).
Conclusion:
According to the
results despite of more than half of the patients ingested paracetamol at toxic
doses, at most of them severity of intoxication was mild. Levels of the liver
function tests of the patients could increase at paracetamol intoxication
compared to baseline levels.
Keywords
References
- 1. Oliver LH, Lewis SN. Acetaminophen. In Judith E.Tintinalli,MD,MS, Editor. Emergency Medicine.7th ed. New York: McGraw-Hill;2010.p.1246-52.
- 2. Hendrickson RG, Bizovi KE. Acetaminophene. In Flomenbaum NE, Goldfrank LR, Hoffman RS, Howland MA, Lewin NA, et al Editors. Goldfrank’s Toxicologic Emergencies. 8th ed. New York: McGraw-Hill; 2006. p.333-43.
- 3. Rumack BH, Matthew H. Acetaminophen poisoning and toxicity. Pediatrics 1975; 55: 871-6.
- 4. Prior MJ, Cooper K, Cummins P, Bowen D: Acetaminophen availability increases in Canada with no increase in the incidence of reports of inpatient hospitalizations with acetaminophen overdose and acute liver toxicity. Am J Ther 2004, 11:443-452.
- 5. Akinci E, Sert ET, Koylu R. İntoksikasyonlarda serum laktat düzeyleri ve tedavinin etkinliğinin belirlenmesinde laktat klirenslerinin kullanılması Turkish Medical Journal 2012:6.
- 6. Brok J, Buckley N, Gluud C. Interventions for paracetamol (acetaminophen) overdose. Cochrane Database Syst Rev 2006; 19: CD003328.
- 7. Koylu R, Dundar ZD, Koylu O, Akinci E, Akilli NB, Gonen MO, et al. The experiences in a toxicology unit: a review of 623 cases. J Clin Med Res. 2014;6:59-65.
- 8. Read RB, Tredger JM, Williams R. Analysis of factors responsible for continuing mortality after paracetamol overdose. Hum Toxicol 1986; 5:201.
- 9. Ambre J, Alexander M. Liver toxicity after acetaminophen ingestion. Inadequacy of the dose estimate as an index of risk. JAMA 1977; 238:500.
- 10. Karaman K, Avcil M, Kantekin B, Özlüer YE, Yaşar HE, Avcil S, et al. Evaluation of Patients with Paracetamol Intoxication Who Admitted to Emergency Service Meandros Medical Journal 2016;17:11-6.
- 11. Lam FW, Rumbaut RE. Platelets mediate acetaminophen hepatotoxicity. Blood. 2015; 126:1738-9.
- 12. Munsterhjelm E, Munsterhjelm NM, Niemi TT, Ylikorkala O, Neuvonen PJ, Rosenberg PH. Dose-dependent inhibition of platelet function by acetaminophen in healthy volunteers. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2005;103:712-7.
- 13. Shorr RI, Kao KJ, Pizzo SV, Rauckman EJ, Rosen GM. In vitro effects of acetaminophen and its analogues on human platelet aggregation and thromboxane B2 synthesis. Thromb Res 1985; 38: 33-43.
- 14. Niemi TT, Backman JT, Syrjala MT, Viinikka LU, Rosenberg PH. Platelet dysfunction after intravenous ketorolac or propacetamol. Acta Anaesthesiol Scand 2000; 44: 69-74.
- 15. Ferner RE, Dear JW, Bateman DN. Management of paracetamol poisoning. BMJ2011; 342: d2218.
- 16. Whyte IM, Buckley NA, Reith DM, Goodhew I, Seldon M, Dawson AH. Acetaminophen causes an increased international normalised ratio by reducing functional factor VII. Ther Drug Monit 2000; 22: 742-8.
- 17. Green TJ, Sivilotti ML, Langmann C, Yarema M, Juurlink D, Burns MJ, et al. When do the aminotransferases rise after acute acetaminophen overdose? Clin Toxicol (Phila) 2010;48(8):787-92.
- 18. Levine M, O'Connor AD, Padilla-Jones A, Gerkin R. Comparison of prothrombin time and aspartate aminotransferase in predicting hepatotoxicity after acetaminophen overdose: a response. J Med Toxicol 2016;12(2): 218.
- 19. Martello JL, Pummer TL, Krenzelok EP. Cost minimization analysis comparing enteral N-acetylcysteine to intravenous acetylcysteine in the management of acute acetaminophen toxicity. Clin Toxicol (Phila) 2010;48(1):79-83.
Abstract
Amaç: Bu çalışmada, acil kliniğine parasetamol intoksikasyonu nedeniyle başvuran hastaların; demografik, klinik değişkenleri, tedavileri ve komplikasyonlarını değerlendirmeyi amaçladık.
Materyal ve Metot: Bu çalışma retrospektif bir çalışmadır. Keçiören Sağlık Araştırma ve Uygulama Merkezi Hastanesi acil kliniğinde parasetamol intoksikasyonu tanısı alan hastalar çalışmaya dahil edildi. Verileri eksik olanlar, gebeler, parasetamol dışı ilaçlarla zehirlenen hastalar çalışma dışı bırakıldı. Verilerin analizi SPSS 16 programında yapıldı. p<0.05 istatistiksel olarak anlamlı kabul edildi.
Bulgular: Çalışmaya 55 hasta dahil edildi. Hastaların yaş ortalaması 34±12 yıl olup, %63,6’sı kadındı. Hastaların aldıkları parasetamol miktarı 11.02±4.04 gr ve dördüncü saat parasetamol düzeyleri 28.8 µg/dl (IQR 25-75: 12.5-41.7) olarak bulundu. Hastaların aldıkları parasetamol miktarı ile kan parasetamol düzeyi arasında istatistiksel anlamlı zayıf düzeyde korelasyon saptandı (r=0,475 ve p=0,04). Hastaların takip süresince bakılan karaciğer fonksiyon testlerinde artış saptandı ve bu fark istatistiksel olarak anlamlıydı (p<0.05).
Sonuç: Çalışma bulgularımıza göre hastalarımız yarıdan fazlası toksik doz parasetamol almış olmasına rağmen büyük bir kısmında zehirlenme şiddetinin hafif olduğu görülmüştür. Parasetamol zehirlenmelerinde hastaların karaciğer fonksiyon testlerinde başlangıç değerlerine göre artış olabilmektedir.
References
- 1. Oliver LH, Lewis SN. Acetaminophen. In Judith E.Tintinalli,MD,MS, Editor. Emergency Medicine.7th ed. New York: McGraw-Hill;2010.p.1246-52.
- 2. Hendrickson RG, Bizovi KE. Acetaminophene. In Flomenbaum NE, Goldfrank LR, Hoffman RS, Howland MA, Lewin NA, et al Editors. Goldfrank’s Toxicologic Emergencies. 8th ed. New York: McGraw-Hill; 2006. p.333-43.
- 3. Rumack BH, Matthew H. Acetaminophen poisoning and toxicity. Pediatrics 1975; 55: 871-6.
- 4. Prior MJ, Cooper K, Cummins P, Bowen D: Acetaminophen availability increases in Canada with no increase in the incidence of reports of inpatient hospitalizations with acetaminophen overdose and acute liver toxicity. Am J Ther 2004, 11:443-452.
- 5. Akinci E, Sert ET, Koylu R. İntoksikasyonlarda serum laktat düzeyleri ve tedavinin etkinliğinin belirlenmesinde laktat klirenslerinin kullanılması Turkish Medical Journal 2012:6.
- 6. Brok J, Buckley N, Gluud C. Interventions for paracetamol (acetaminophen) overdose. Cochrane Database Syst Rev 2006; 19: CD003328.
- 7. Koylu R, Dundar ZD, Koylu O, Akinci E, Akilli NB, Gonen MO, et al. The experiences in a toxicology unit: a review of 623 cases. J Clin Med Res. 2014;6:59-65.
- 8. Read RB, Tredger JM, Williams R. Analysis of factors responsible for continuing mortality after paracetamol overdose. Hum Toxicol 1986; 5:201.
- 9. Ambre J, Alexander M. Liver toxicity after acetaminophen ingestion. Inadequacy of the dose estimate as an index of risk. JAMA 1977; 238:500.
- 10. Karaman K, Avcil M, Kantekin B, Özlüer YE, Yaşar HE, Avcil S, et al. Evaluation of Patients with Paracetamol Intoxication Who Admitted to Emergency Service Meandros Medical Journal 2016;17:11-6.
- 11. Lam FW, Rumbaut RE. Platelets mediate acetaminophen hepatotoxicity. Blood. 2015; 126:1738-9.
- 12. Munsterhjelm E, Munsterhjelm NM, Niemi TT, Ylikorkala O, Neuvonen PJ, Rosenberg PH. Dose-dependent inhibition of platelet function by acetaminophen in healthy volunteers. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2005;103:712-7.
- 13. Shorr RI, Kao KJ, Pizzo SV, Rauckman EJ, Rosen GM. In vitro effects of acetaminophen and its analogues on human platelet aggregation and thromboxane B2 synthesis. Thromb Res 1985; 38: 33-43.
- 14. Niemi TT, Backman JT, Syrjala MT, Viinikka LU, Rosenberg PH. Platelet dysfunction after intravenous ketorolac or propacetamol. Acta Anaesthesiol Scand 2000; 44: 69-74.
- 15. Ferner RE, Dear JW, Bateman DN. Management of paracetamol poisoning. BMJ2011; 342: d2218.
- 16. Whyte IM, Buckley NA, Reith DM, Goodhew I, Seldon M, Dawson AH. Acetaminophen causes an increased international normalised ratio by reducing functional factor VII. Ther Drug Monit 2000; 22: 742-8.
- 17. Green TJ, Sivilotti ML, Langmann C, Yarema M, Juurlink D, Burns MJ, et al. When do the aminotransferases rise after acute acetaminophen overdose? Clin Toxicol (Phila) 2010;48(8):787-92.
- 18. Levine M, O'Connor AD, Padilla-Jones A, Gerkin R. Comparison of prothrombin time and aspartate aminotransferase in predicting hepatotoxicity after acetaminophen overdose: a response. J Med Toxicol 2016;12(2): 218.
- 19. Martello JL, Pummer TL, Krenzelok EP. Cost minimization analysis comparing enteral N-acetylcysteine to intravenous acetylcysteine in the management of acute acetaminophen toxicity. Clin Toxicol (Phila) 2010;48(1):79-83.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Emergency Medicine |
| Journal Section | Original Articles |
| Authors | |
| Publication Date | March 1, 2019 |
| Submission Date | January 24, 2019 |
| Published in Issue | Year 2019 Volume: 1 Issue: 1 |
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