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8 Pitfalls in Recognition and Management of Acetaminophen Toxicity

By Anton Helman, MD, CCFP(EM), FCFP | on May 8, 2023 | 0 Comment
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ACEP Now: Vol 42 – No 05 – May 2023

References

  1. Sivilotti MLA, Yarema MC, Juurlink DN. Treating acetaminophen overdose. CMAJ. 2022;194:E554–E554.
  2. Agrawal S, Khazaeni B. Acetaminophen toxicity. In: StatPearls. Treasure Island, Florida: StatPearls Publishing; 2022. https://www.ncbi.nlm.nih.gov/books/NBK441917/. Published January, 2022. Updated February 12, 2023. Accessed April 2, 2023.
  3. Mehrpour O, Saeedi F, Hadianfar A, Mégarbane B, Hoyte C. Prognostic factors of acetaminophen exposure in the United States: An analysis of 39,000 patients. Hum Exp Toxicol. 2021;40S:814–S825.
  4. Sivilotti MLA, Yarema MC, Juurlink DN. Treating acetaminophen overdose. CMAJ. 2022;194:E554–E554.
  5. Sivilotti MLA, Green TJ, Langmann C, Yarema M, Juurlink D, Johnson D. Multiplying the serum aminotransferase by the acetaminophen concentration to predict toxicity following overdose. Clin Toxicol. 2010;48:793–799.
  6. Levine M, Stellpflug SJ, Pizon AF, et al. Hypoglycemia and lactic acidosis outperform King’s College criteria for predicting death or transplant in acetaminophen toxic patients. Clin Toxicol. 2018;56:622–625.
  7. Bernal W, Donaldson N, Wyncoll D, Wendon J. Blood lactate as an early predictor of outcome in paracetamol-induced acute liver failure: a cohort study. Lancet. 2002;359: 558–563.
  8. Schmidt LE, Dalhoff K. Serum phosphate is an early predictor of outcome in severe acetaminophen-induced hepatotoxicity. Hepatology. 2002 Sep;36(3):659-65.
  9. Bernal W, Donaldson N, Wyncoll D, Wendon J. Blood lactate as an early predictor of outcome in paracetamol-induced acute liver failure: a cohort study. Lancet. 2002;359:558–563.
  10. Bond GR, Hite LK. Population-based incidence and outcome of acetaminophen poisoning by type of ingestion. Acad Emerg Med. 1999;6:1115–1120.
  11. Green JL, Heard KJ, Reynolds KM, Albert D. Oral and intravenous acetylcysteine for treatment of acetaminophen toxicity: a systematic review and meta-analysis. West J Emerg Med. 2013;14:218–226.
  12. Hendrickson RG. What is the most appropriate dose of N-acetylcysteine after massive acetaminophen overdose? Clin Toxicol (Phila). 2019;57:686–691.
  13. Sivilotti MLA, Juurling DN, Garland JS, et al. Antidote removal during haemodialysis for massive acetaminophen overdose. Clin Toxicol (Phila). 2013;51:855–863.
  14. Chiew AL, Reith D, Pomerleau A, et al. Updated guidelines for the management of paracetamol poisoning in Australia and New Zealand. Med J Aust. 2020;212:175–183.
  15. Woolum JA, Hays WB, Patel KH. Use of fomepizole, N-acetylcysteine, and hemodialysis for massive acetaminophen overdose. Am J Emerg Med. 2020;38:692.e5-692.e7.
  16. Gosselin S, Juurlink DN, Kielstein JT, et al. Extracorporeal treatment for acetaminophen poisoning: Recommendations from the EXTRIP workgroup. Clin Toxicol. 2014;52:856–867.

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Topics: acetaminophenClinicalPoisontoxicityToxin

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