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treatment acetaminophen poisoning

Jimmy Donkor, Patil Armenian, Isaac N Hartman, Rais Vohra
BACKGROUND: As decontamination trends have evolved, gastric lavage (GL) has become a rare procedure. The current information regarding use, outcomes, and complications of GL could help refine indications for this invasive procedure. OBJECTIVES: We sought to determine case type, location, and complications of GL cases reported to a statewide poison control system. METHODS: This is a retrospective review of the California Poison Control System (CPCS) records from 2009 to 2012...
October 2016: Journal of Emergency Medicine
B Alyahya, S Tamur, S Aljenedil, A Larocuque, E Holody, S Gosselin
BackgroundReduced gastrointestinal motility can alter the toxicokinetics of acetaminophen poisoning. We report a case of altered acetaminophen toxicokinetics due to delayed gastrointestinal absorption, likely secondary to intestinal trauma/surgery.  Case ReportA 37-year-old woman ingested an unknown amount of acetaminophen and ethanol then stabbed herself in the abdomen. The initial acetaminophen was 1,285.9 μmol/L and the time of ingestion was not known. Intravenous acetylcysteine protocol was started. She developed an ileus post-surgery for the stab wounds...
2016: Journal of Population Therapeutics and Clinical Pharmacology
Matthew D Hensley, Vikhyat S Bebarta, Douglas J Borys
OBJECTIVE: Significant adverse effects after acute pediatric methotrexate (MTX) exposures have been limited to parenteral exposures. Treatment recommendations for pediatric MTX exposures do not differentiate between routes of exposure. We report the incidence of significant clinical effects and drug-specific treatments reported in a large series of acute, pediatric MTX ingestions. METHODS: Poison center records of all MTX ingestions by patients younger than 17 years during 2000 to 2005 were collected from 6 poison centers...
July 2, 2016: Pediatric Emergency Care
Maciej Krasnodębski, Michał Grąt, Wacław Hołówko, Łukasz Masior, Karolina M Wronka, Karolina Grąt, Jan Stypułkowski, Waldemar Patkowski, Marek Krawczyk
INTRODUCTION: Amanita phalloides and paracetamol intoxications are responsible for the majority of acute liver failures. AIM: To assess survival outcomes and to analyse risk factors affecting survival in the studied group. MATERIAL AND METHODS: Of 1369 liver transplantations performed in the Department of General, Transplant, and Liver Surgery, Medical University of Warsaw before December 2013, 20 (1.46%) patients with Amanita phalloides (n = 13, 0...
2016: Przegla̜d Gastroenterologiczny
Sarbjeet S Kalsi, Paul I Dargan, W Stephen Waring, David M Wood
Paracetamol (acetaminophen) poisoning is common throughout the world. The management of nonstaggered (acute) paracetamol overdose is based on the plasma paracetamol concentration plotted on a treatment nomogram. In the UK there are two treatment lines on this nomogram, with the lower treatment line used for individuals felt to be at 'high risk' of paracetamol-related hepatotoxicity either as a result of induction of cytochrome P450 isoenzymes or reduction of intrahepatic glutathione. In this article we review the risk factors that, in current guidelines, are felt to increase risk due to a reduction in intrahepatic glutathione concentrations...
2011: Open Access Emergency Medicine: OAEM
Marc Ghannoum, Sara Kazim, Ami M Grunbaum, Eric Villeneuve, Sophie Gosselin
CONTEXT: Early onset acidosis from mitochondrial toxicity can be observed in massive acetaminophen poisoning prior to the development of hepatotoxicity. In this context, the efficacy of acetylcysteine to reverse mitochondrial toxicity remains unclear and hemodialysis may offer prompt correction of acidosis. Unfortunately, toxicokinetics of acetaminophen and acetylcysteine during extracorporeal treatments hemodialysis have seldom been described. CASE DETAILS: An 18-year-old woman presented to the emergency department 60 minutes after ingestion of 100 g of acetaminophen, and unknown amounts of ibuprofen and ethanol...
July 2016: Clinical Toxicology
Luiz Anastácio Alves, André Bonavita, Kátia Quaresma, Elenilde Torres, Paulo Anastácio Furtado Pacheco, Vinícius Cotta-de-Almeida, Roberto Magalhães Saraiva
Acute liver failure (ALF) has a poor prognosis and, despite intensive care support, reported average survival is only 10-40%. The most common causes responsible for ALF are viral hepatitis (mainly hepatitis A and B) and acetaminophen poisoning. Hepatic transplantation is the only appropriate treatment for patients with unlikely survival with supportive care alone. Survival rates after transplantation can be as high as 80-90% at the end of the first year. However, there is a shortage of donors and is not uncommon that no appropriate donor matches with the patient in time to avoid death...
2010: Cell Medicine
Scott N Lucyk, Mark C Yarema, Marco L A Sivilotti, David W Johnson, Alberto Nettel-Aguirre, Charlemaigne Victorino, Benoit Bailey, Richard C Dart, Kennon Heard, Daniel A Spyker, Barry H Rumack
BACKGROUND: The minimum recommended treatment duration for i.v. N-acetylcysteine (NAC) after an acute, single acetaminophen (APAP) overdose is 21 h. Some have questioned whether shorter courses may be sufficient in carefully selected cases. OBJECTIVE: We sought to describe the incidence of hepatotoxicity in a cohort of acute APAP overdose patients who received <21 h of i.v. NAC for any reason. METHODS: We performed a secondary analysis of a large multicenter retrospective cohort of patients hospitalized for APAP poisoning...
April 2016: Journal of Emergency Medicine
Tadeusz Wróblewski, Konrad Kobryń, Sławomir Kozieł, Urszula Ołdakowska-Jedynak, Jarosław Pinkas, Roman Danielewicz, Bogna Ziarkiewicz-Wróblewska, Marek Krawczyk
INTRODUCTION: The widespread availability of medication without prescription, so-called over the counter (OTC), and the rapid development of health consciousness of Poles is associated with broad access to medical information in the mass media. This causes patients to recognize their own disease, cancel doctor's appointments, and begin self-treatment. This time and money-saving behavior, often signaled by pain, usually leads to the treatment of symptoms alone, without seeking the cause of the disease...
2015: Annals of Agricultural and Environmental Medicine: AAEM
Murat Polat, Serkan Cerrah, Bulent Albayrak, Serkan Ipek, Mahmut Arabul, Fatih Aslan, Omer Yilmaz
Background Aim. In case of high-dose acetaminophen intake, the active metabolite can not bind to the glutathione, thereby inducing cellular necrosis through binding to the cytosol proteins. This trial was performed to histologically and biochemically investigate whether leptin was protective against liver damage induced by paracetamol at toxic doses. Material and Method. In our trial, 30 female rats, divided into 5 groups, were used. IP leptin administration was performed after an hour in the group of rats, in which paracetamol poisoning was induced...
2015: Gastroenterology Research and Practice
Cristian Papazoglu, Jonathan R Ang, Michael Mandel, Prasanta Basak, Stephen Jesmajian
Acetaminophen is the most commonly used analgesic-antipyretic medication in the United States. Acetaminophen overdose, a frequent cause of drug toxicity, has been recognized as the leading cause of fatal and non-fatal hepatic necrosis. N-Acetylcysteine is the recommended antidote for acetaminophen poisoning. Despite evidence on the efficacy of N-acetylcysteine for prevention of hepatic injury, controversy persists about the optimal duration of the therapy. Here, we describe the case of a 65-year-old male with acetaminophen overdose and opioid co-ingestion who developed a second peak in acetaminophen serum levels after completing the recommended 21-hour intravenous N-acetylcysteine protocol and when the standard criteria for monitoring drug levels was achieved...
2015: Journal of Community Hospital Internal Medicine Perspectives
Jonathan G Stine, James H Lewis
While the pace of discovery of new agents, mechanisms and risk factors involved in drug-induced liver injury (DILI) remains brisk, advances in the treatment of acute DILI seems slow by comparison. In general, the key to treating suspected DILI is to stop using the drug prior to developing irreversible liver failure. However, predicting when to stop is an inexact science, and commonly used ALT monitoring is an ineffective strategy outside of clinical trials. The only specific antidote for acute DILI remains N-acetylcysteine (NAC) for acetaminophen poisoning, although NAC is proving to be beneficial in some cases of non-acetaminophen DILI in adults...
2016: Expert Review of Gastroenterology & Hepatology
L A Denzoin Vulcano, O Confalonieri, R Franci, M O Tapia, A L Soraci
Acetaminophen (APAP) administration results in hepatotoxicity and hematotoxicity in cats. The response to three different treatments against APAP poisoning was evaluated. Free glutathione (GSH) (200mg/kg), niosomal GSH (14 mg/kg) and free amino acids (180 mg/kg of N-acetylcysteine and 280 mg/kg of methionine) were administered to cats that were intoxicated with APAP (a single dose of 150 mg/kg, p.o.). Serum concentration of alanine aminotransferase (ALT) along with serum, liver and erythrocyte concentration of GSH and methemoglobin percentage were measured before and 4, 24 and 72 hours after APAP administration...
2013: Open veterinary journal
Ronald I Kirschner, Christina M Rozier, Lynette M Smith, Kathy L Jacobitz
BACKGROUND: The Rumack-Matthew nomogram predicts the risk of hepatotoxicity following acute acetaminophen overdose based on a serum concentration obtained ≥ 4-hour post-ingestion. Some patients with low-risk concentrations at 4 hours may have subsequent values indicating increased risk (above the nomogram treatment line), especially if coingestants that slow gastrointestinal motility are involved. The treatment line currently used to identify low risk patients in the United States, Canada, and Australia begins at 150 mcg/mL (993 μmol/L) and intersects at 18...
2016: Clinical Toxicology
Marc Ghannoum, Valery Lavergne, Sophie Gosselin, James B Mowry, Lotte C G Hoegberg, Mark Yarema, Margaret Thompson, Nancy Murphy, John Thompson, Roy Purssell, Robert S Hoffman
Extracorporeal treatments (ECTRs) such as hemodialysis (HD), enhance the elimination of a small number of toxins. Changes in overdose trends, prescribing practices, antidotes, and dialysis techniques may alter the indications and rates of ECTR use over time. This study analyzed trends in ECTR for poisonings in four countries. A retrospective study of national poison center databases from the United States, Denmark, United Kingdom, and five regional databases within Canada was performed. All cases of patients receiving an ECTR were included...
January 2016: Seminars in Dialysis
Kuo Du, Mitchell R McGill, Yuchao Xie, Hartmut Jaeschke
Acetaminophen (APAP) hepatotoxicity is a serious public health problem in western countries. Current treatment options for APAP poisoning are limited and novel therapeutic intervention strategies are needed. A recent publication suggested that benzyl alcohol (BA) protects against APAP hepatotoxicity and could serve as a promising antidote for APAP poisoning. To assess the protective mechanisms of BA, C56Bl/6J mice were treated with 400 mg/kg APAP and/or 270 mg/kg BA. APAP alone caused extensive liver injury at 6 h and 24 h post-APAP...
December 2015: Food and Chemical Toxicology
B Kevin Park, James W Dear, Daniel J Antoine
INTRODUCTION: Paracetamol directly causes around 150 deaths per year in UK. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of treatments for acute paracetamol poisoning? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview)...
2015: Clinical Evidence
Christin Giordano, John Rivas, Xaralambos Zervos
Drug-induced liver injury (DILI) has been linked to more than 1,000 medications and remains the most common cause of acute liver failure in the United States. Here, we review the most current literature regarding treatment and make recommendations for the management of this relatively common disease. Since treatment of DILI remains largely elusive, recent studies have attempted to define new management strategies for these difficult patients. Early diagnosis and withdrawal of the suspected medication is the mainstay of treatment of DILI...
June 2014: Journal of Clinical and Translational Hepatology
Niharika Behal, Alan Wong, Ruzly Mantara, F Lee Cantrell
There are over 2 million human exposure cases reported to United States poison centers annually. Much of the data involves exposure through ingestion, dermal contact, inhalation, ocular, or parenteral routes. There is limited data characterizing exposure via atypical routes. We conducted a retrospective review of the California Poison Control System Database for a 24-month period from January 2012 to December 2013 for poison exposure that occurred through the otic, vaginal, or rectal route. There were a total of 634 cases involving single-route and single-substance atypical poison exposure...
February 2016: Journal of Community Health
Kuo Du, Yuchao Xie, Mitchell R McGill, Hartmut Jaeschke
BACKGROUND: Acetaminophen (APAP) overdose is the leading cause of acute liver failure in the US. Although substantial progress regarding the mechanisms of APAP hepatotoxicity has been made in the past several decades, therapeutic options are still limited and novel treatments are clearly needed. c-jun N-terminal Kinase (JNK) has emerged as a promising therapeutic target in recent years. AREAS COVERED: Early studies established the critical role of JNK activation and mitochondrial translocation in APAP hepatotoxicity...
2015: Expert Opinion on Drug Metabolism & Toxicology
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