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False positive acetaminophen concentrations in icteric serum

INTRODUCTION: Serum concentrations of acetaminophen are measured to predict the risk of hepatotoxicity in cases of acetaminophen overdose and to identify acetaminophen use in patients with acute liver injury without a known cause. The acetaminophen concentration determines if treatment with N-acetyl...

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Autores principales: de Jong, L., Knapen, D.G., Oude Munnink, T.H., Henstra, M.J., Veneman, T.F.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574514/
https://www.ncbi.nlm.nih.gov/pubmed/28856191
http://dx.doi.org/10.1016/j.plabm.2015.12.003
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author de Jong, L.
Knapen, D.G.
Oude Munnink, T.H.
Henstra, M.J.
Veneman, T.F.
author_facet de Jong, L.
Knapen, D.G.
Oude Munnink, T.H.
Henstra, M.J.
Veneman, T.F.
author_sort de Jong, L.
collection PubMed
description INTRODUCTION: Serum concentrations of acetaminophen are measured to predict the risk of hepatotoxicity in cases of acetaminophen overdose and to identify acetaminophen use in patients with acute liver injury without a known cause. The acetaminophen concentration determines if treatment with N-acetyl cysteine, the antidote for acetaminophen poisoning, is warranted. DESCRIPTION: A 49-year-old woman was admitted to our hospital with a hepatic encephalopathy and a total serum bilirubin concentration of 442 µmol/l. The acetaminophen concentration of 11.5 mg/l was measured with an enzymatic-colorimetric assay, thus treatment with N-acetyl cysteine was started. Interestingly, the acetaminophen concentration remained unchanged (11.5–12.3 mg/l) during a period of 4 consecutive days. In contrast, the acetaminophen concentration measured by HPLC, a chromatographic technique, remained undetectable DISCUSSION: In the presented case, elevated bilirubin was the most likely candidate to interfere with acetaminophen assay causing false positive results. Bilirubin has intense absorbance in the ultraviolet and visible regions of the electromagnetic spectrum and for that reason it causes interference in an enzymatic-colorimetric assay. CONCLUSION: False positive acetaminophen laboratory test results may be found in icteric serum, when enzymatic-colorimetric assays are used for determination of an acetaminophen concentration. Questionable acetaminophen results in icteric serum should be confirmed by a non-enzymatic method, by means of ultrafiltration of the serum, or by dilution studies.
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spelling pubmed-55745142017-08-30 False positive acetaminophen concentrations in icteric serum de Jong, L. Knapen, D.G. Oude Munnink, T.H. Henstra, M.J. Veneman, T.F. Pract Lab Med Case Report INTRODUCTION: Serum concentrations of acetaminophen are measured to predict the risk of hepatotoxicity in cases of acetaminophen overdose and to identify acetaminophen use in patients with acute liver injury without a known cause. The acetaminophen concentration determines if treatment with N-acetyl cysteine, the antidote for acetaminophen poisoning, is warranted. DESCRIPTION: A 49-year-old woman was admitted to our hospital with a hepatic encephalopathy and a total serum bilirubin concentration of 442 µmol/l. The acetaminophen concentration of 11.5 mg/l was measured with an enzymatic-colorimetric assay, thus treatment with N-acetyl cysteine was started. Interestingly, the acetaminophen concentration remained unchanged (11.5–12.3 mg/l) during a period of 4 consecutive days. In contrast, the acetaminophen concentration measured by HPLC, a chromatographic technique, remained undetectable DISCUSSION: In the presented case, elevated bilirubin was the most likely candidate to interfere with acetaminophen assay causing false positive results. Bilirubin has intense absorbance in the ultraviolet and visible regions of the electromagnetic spectrum and for that reason it causes interference in an enzymatic-colorimetric assay. CONCLUSION: False positive acetaminophen laboratory test results may be found in icteric serum, when enzymatic-colorimetric assays are used for determination of an acetaminophen concentration. Questionable acetaminophen results in icteric serum should be confirmed by a non-enzymatic method, by means of ultrafiltration of the serum, or by dilution studies. Elsevier 2015-12-17 /pmc/articles/PMC5574514/ /pubmed/28856191 http://dx.doi.org/10.1016/j.plabm.2015.12.003 Text en © 2016 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
de Jong, L.
Knapen, D.G.
Oude Munnink, T.H.
Henstra, M.J.
Veneman, T.F.
False positive acetaminophen concentrations in icteric serum
title False positive acetaminophen concentrations in icteric serum
title_full False positive acetaminophen concentrations in icteric serum
title_fullStr False positive acetaminophen concentrations in icteric serum
title_full_unstemmed False positive acetaminophen concentrations in icteric serum
title_short False positive acetaminophen concentrations in icteric serum
title_sort false positive acetaminophen concentrations in icteric serum
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574514/
https://www.ncbi.nlm.nih.gov/pubmed/28856191
http://dx.doi.org/10.1016/j.plabm.2015.12.003
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