- Title
- Retrospective evaluation of repeated supratherapeutic ingestion (RSTI) of paracetamol
- Creator
- Egan, Harry; Isbister, Geoffrey K.; Robinson, Jennifer; Downes, Michael; Chan, Betty S.; Vecellio, Elia; Chiew, Angela L.
- Relation
- NHMRC.ID1061041 http://purl.org/au-research/grants/nhmrc/1061041
- Relation
- Clinical Toxicology Vol. 57, Issue 8, p. 703-711
- Publisher Link
- http://dx.doi.org/10.1080/15563650.2018.1547829
- Publisher
- Taylor & Francis
- Resource Type
- journal article
- Date
- 2019
- Description
- Background: Repeated supratherapeutic ingestion (RSTI) of paracetamol can result in acute liver injury. Management guidelines vary worldwide and in Australia, acetylcysteine treatment is recommended in patients with a paracetamol concentration ≥20 mg/L and/or alanine transaminase (ALT) ≥50 U/L. Objectives: To investigate patients with RSTI of paracetamol and determine whether admission ALT <50 U/L rules out those who develop hepatotoxicity (ALT >1000 U/L). Method: Retrospective review of paracetamol RSTI presentations to two toxicology services over a four-year period. Patients were included if they ingested >4 g per 24 h of paracetamol for a period >8 h, regardless of intent. Data collected included demographics, ingestion history, pathology results, treatments and outcomes. Results: 266 patients were identified with median ingested dose of 9 g per 24 h (IQR: 6–12 g) over a median of 2 days (IQR: 1–5 days). On presentation, paracetamol was detected in 192 (72%), with median concentration of 14 mg/L (IQR: 7–27 mg/L). Median ALT on admission in those developing hepatotoxicity was significantly higher, 1182 U/L (IQR: 598–4251 U/L), compared to 30 U/L (IQR: 18–59 U/L; p < .0001) in those who did not. All 17 who developed hepatotoxicity had an ALT ≥50 U/L on presentation. Five patients presenting with an ALT <50 U/L developed a peak ALT between 50 and 1000 U/L, of which three had a paracetamol concentration <20 mg/L. 139 (52%) received acetylcysteine, of which 64 received an abbreviated course (<20 h), with a median length of infusion of 11 h (IQR: 7–14 h). 127 (48%) patients were not treated with acetylcysteine, none of these patients returned to hospital. Conclusions: Our results confirm that those developing hepatotoxicity from RSTI of paracetamol have an elevated ALT on presentation. Presenting ALT <50 U/L appears to be a safe threshold not to administer acetylcysteine, provided the paracetamol concentration is low.
- Subject
- paracetamol; hepatotoxicity; acetylcysteine; repeated supratherapeutic ingestion
- Identifier
- http://hdl.handle.net/1959.13/1467033
- Identifier
- uon:47721
- Identifier
- ISSN:1556-3650
- Language
- eng
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