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Pattern of Paracetamol Poisoning: Influence on Outcome and Complications

Acute paracetamol poisoning due to a single overdose may be effectively treated by the early administration of N-acetylcysteine (NAC) as an antidote. The prognosis may be different in the case of intoxication due to multiple ingestions or when the antidote is started with delay. The aim of this work...

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Autores principales: Castanares-Zapatero, Diego, Dinant, Valérie, Ruggiano, Ilaria, Willem, Harold, Laterre, Pierre-François, Hantson, Philippe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6315900/
https://www.ncbi.nlm.nih.gov/pubmed/30274302
http://dx.doi.org/10.3390/toxics6040058
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author Castanares-Zapatero, Diego
Dinant, Valérie
Ruggiano, Ilaria
Willem, Harold
Laterre, Pierre-François
Hantson, Philippe
author_facet Castanares-Zapatero, Diego
Dinant, Valérie
Ruggiano, Ilaria
Willem, Harold
Laterre, Pierre-François
Hantson, Philippe
author_sort Castanares-Zapatero, Diego
collection PubMed
description Acute paracetamol poisoning due to a single overdose may be effectively treated by the early administration of N-acetylcysteine (NAC) as an antidote. The prognosis may be different in the case of intoxication due to multiple ingestions or when the antidote is started with delay. The aim of this work was to investigate the outcome of paracetamol poisoning according to the pattern of ingestion and determine the factors associated with the outcome. We performed a retrospective analysis over the period 2007–2017 of the patients who were referred to a tertiary hospital for paracetamol-related hepatotoxicity. Inclusion criteria were: accidental or voluntary ingestion of paracetamol, delay for NAC therapy of 12 h or more, liver enzymes (ALT) >1000 IU/L on admission. Ninety patients were considered. Poisoned patients following multiple ingestion were significantly older (45 ± 12 vs. 33 ± 14) (p = 0.001), with a higher incidence of liver steatosis (p = 0.016) or chronic ethanol abuse (p = 0.04). In comparison with the subgroup of favorable outcome, the patients with poor outcome were older, had higher values for ALT, bilirubin, lactate, and lower values for factor V and arterial pH. In multivariate analysis, the arterial lactate value was associated with a bad prognosis (p < 0.02) (adjusted odds ratio 1.74 and CI 95:1.09–2.77). The risk of poor outcome was greater in the subgroup with staggered overdose (p = 0.02), which had a higher mortality rate (p = 0.01). This retrospective analysis illustrates the different population patterns of patients who were admitted for a single ingestion of a paracetamol overdose versus multiple ingestions. This last subgroup was mainly represented by older patients with additional risk factors for hepatotoxicity; arterial lactate was a good predictor of severity.
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spelling pubmed-63159002019-01-11 Pattern of Paracetamol Poisoning: Influence on Outcome and Complications Castanares-Zapatero, Diego Dinant, Valérie Ruggiano, Ilaria Willem, Harold Laterre, Pierre-François Hantson, Philippe Toxics Article Acute paracetamol poisoning due to a single overdose may be effectively treated by the early administration of N-acetylcysteine (NAC) as an antidote. The prognosis may be different in the case of intoxication due to multiple ingestions or when the antidote is started with delay. The aim of this work was to investigate the outcome of paracetamol poisoning according to the pattern of ingestion and determine the factors associated with the outcome. We performed a retrospective analysis over the period 2007–2017 of the patients who were referred to a tertiary hospital for paracetamol-related hepatotoxicity. Inclusion criteria were: accidental or voluntary ingestion of paracetamol, delay for NAC therapy of 12 h or more, liver enzymes (ALT) >1000 IU/L on admission. Ninety patients were considered. Poisoned patients following multiple ingestion were significantly older (45 ± 12 vs. 33 ± 14) (p = 0.001), with a higher incidence of liver steatosis (p = 0.016) or chronic ethanol abuse (p = 0.04). In comparison with the subgroup of favorable outcome, the patients with poor outcome were older, had higher values for ALT, bilirubin, lactate, and lower values for factor V and arterial pH. In multivariate analysis, the arterial lactate value was associated with a bad prognosis (p < 0.02) (adjusted odds ratio 1.74 and CI 95:1.09–2.77). The risk of poor outcome was greater in the subgroup with staggered overdose (p = 0.02), which had a higher mortality rate (p = 0.01). This retrospective analysis illustrates the different population patterns of patients who were admitted for a single ingestion of a paracetamol overdose versus multiple ingestions. This last subgroup was mainly represented by older patients with additional risk factors for hepatotoxicity; arterial lactate was a good predictor of severity. MDPI 2018-09-29 /pmc/articles/PMC6315900/ /pubmed/30274302 http://dx.doi.org/10.3390/toxics6040058 Text en © 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Castanares-Zapatero, Diego
Dinant, Valérie
Ruggiano, Ilaria
Willem, Harold
Laterre, Pierre-François
Hantson, Philippe
Pattern of Paracetamol Poisoning: Influence on Outcome and Complications
title Pattern of Paracetamol Poisoning: Influence on Outcome and Complications
title_full Pattern of Paracetamol Poisoning: Influence on Outcome and Complications
title_fullStr Pattern of Paracetamol Poisoning: Influence on Outcome and Complications
title_full_unstemmed Pattern of Paracetamol Poisoning: Influence on Outcome and Complications
title_short Pattern of Paracetamol Poisoning: Influence on Outcome and Complications
title_sort pattern of paracetamol poisoning: influence on outcome and complications
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6315900/
https://www.ncbi.nlm.nih.gov/pubmed/30274302
http://dx.doi.org/10.3390/toxics6040058
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