Paracetamol Poisoning Outcome at Rozhhalat Emergency Hospital- Erbil City

Authors

  • Rawaz Mehdi Aziz Khoshnaw MBChB , Emergency Medicine resident doctor, Rozh-halat emergency hospital/Erbil
  • Halgourd Fathulla Ahmed MBChB , FIBMS (Internal Medicine); Assistant Professor, Kurdistan board of medical specialties/Erbil
  • Karwan Yasin Mohamed 3. MBChB , FKBMS-EM, MRCEM, Specialist in Emergency Medicine , Rozh-halat emergency hospital/Erbil

Keywords:

Outcome, Complications, Management, Paracetamol poisoning

Abstract

Background: Paracetamol poisoning (PP) is a common cause of hepatotoxicity and acute liver failure all over the world. Exploring the management outcomes of paracetamol poisoning is important for evaluation of management guidelines and facilities

Objective: To evaluate the outcomes of paracetamol poisoning in Erbil city and exploring risk factors for adverse outcome of paracetamol poisoning among patients

Patients & Methods: A clinical prospective follow up study conducted in Rozhhalat Emergency Hospital in Erbil city-Kurdistan through the period from 1st of August, 2019 to 31st of July, 2020 on sample of 65 patients with paracetamol poisoning. The patients were followed up for at least 48 hours after management for assessment of complications and outcome

Results: The complications of PP were absent in 90.7% of patients, while PP complications were liver failure (6.2%) and central nervous complications (3.1%). The final outcome of PP patients was either discharged with no complications (90.7%), or discharged with complications (9.3%). The significant risk factors in developing complications of paracetamol poisoning are alcohol consumption, therapeutic dose, increased number of ingested tablets and unstable patients.

Conclusions: The main risk factors in developing complications of paracetamol poisoning are alcohol consumption, therapeutic dose, increased number of ingested tablets and unstable patients

Downloads

Download data is not yet available.

References

Piotrowska N, Klukowska-Rötzler J, Lehmann B, Krummrey G, Haschke M, Exadaktylos AK, et al. Presentations Related to Acute Paracetamol Intoxication in an Urban Emergency Department in Switzerland. Emerg Med Int 2019; 2019:3130843.

Park BK, Dear JW, Antoine DJ. Paracetamol (acetaminophen) poisoning. BMJ Clin Evid 2015; 2015:2101.

Ye H, Nelson LJ, Gómez Del Moral M, Martínez-Naves E, Cubero FJ. Dissecting the molecular pathophysiology of drug-induced liver injury. World J Gastroenterol 2018; 24(13):1373-85.

Kux L. Federal Register Notice: Prescription Drug Products Containing Acetaminophen: Actions to Reduce Liver Injury from Unintentional Overdose. 2014. Available at: https://www.regulations.gov/document?D=FDA

Larson AM, Polson J, Fontana RJ. Acute Liver Failure Study Group. Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study. Hepatology 2005; 42:1364- 72 .

Bernal W, Wendon J. Acute liver failure. N Engl J Med 2013; 369:2525-34 .

Bateman DN, Carroll R, Pettie J. Effect of the UK’s revised paracetamol poisoning management guidelines on admissions, adverse reactions and costs of treatment. Br J Clin Pharmacol 2014; 78: 610–18.

Agrawal S, Khazaeni B. Acetaminophen Toxicity. In: Stat Pearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441917/

Chiew AL, Isbister GK, Duffull SB, Buckley NA. Evidence for the changing regimens of acetylcysteine. Br J Clin Pharmacol 2016; 81: 471–81.

Cairney DG, Beckwith HKS, Al-Hourani K. Plasma paracetamol concentration at hospital presentation has a dose-dependent relationship with liver injury despite prompt treatment with intravenous acetylcysteine. Clin Toxicol 2016; 54: 405–10.

Doyon S, Klein-Schwartz W. Hepatotoxicity despite early administration of intravenous N- acetylcysteine for acute acetaminophen overdose. Acad Emerg Med 2009; 16(1):34–9 .

Hendrickson RG, McKeown NJ, West PL. Bactrian ("double hump") acetaminophen pharmacokinetics: a case series and review of the literature. J Med Toxicol 2010; 6(3):337–44.

Frischknecht J. Order in the house. Setting standards for treatment of acetaminophen toxicity. Adv NPs PAs 2013; 4(3):34-6.

Yoon E, Babar A, Choudhary M, Kutner M, Pyrsopoulos N. Acetaminophen-Induced Hepatotoxicity: a Comprehensive Update. J Clin Transl Hepatol 2016; 4(2):131-42.

Al-Ani ZR, Al-Hiali SJ, Al-Janabi RH. Childhood accidental poisoning in western Iraq: Pattern and risk factors, Alexandria Journal of Medicine 2018; 54:4, 581-6.

Malkhasian AA, Amin YK. Pattern of suicide in Kurdistan region/Iraq in the past three years and methods of recognition. The Medical Journal of Tikrit University 2019; 25 (2): 64-73.

Blieden M, Paramore LC, Shah D, Ben-Joseph R. A perspective on the epidemiology of acetaminophen exposure and toxicity in the United States. Expert Rev Clin Pharmacol 2014; 7: 341- 8.

Michna E, Duh MS, Korves C, Dahl JL. Removal of opioid/acetaminophen combination prescription pain medications: assessing the evidence for hepatotoxicity and consequences of removal of these medications. Pain Med 2010; 11: 369-78.

Pajoumand A, Alinia T, Mahdavinejad A, Talaie H. Puzzling situation of acetaminophen toxicity in a referral hospital, Tehran, Iran. Iranian Journal of Pharmaceutical Sciences 2018; 14(2): 93-102.

Tan CJ, Sklar GE. Characterisation and outcomes of adult patients with paracetamol overdose presenting to a tertiary hospital in Singapore. Singapore Med J 2017; 58(12):695-702.

Tittarelli R, Pellegrini M, Scarpellini MG, Marinelli E, Bruti V, di Luca NM, et al. Hepatotoxicity of paracetamol and related fatalities. Eur Rev Med Pharmacol Sci 2017; 21(1 Suppl):95-101.

Lee WM. Acetaminophen (APAP) hepatotoxicity-Isn't it time for APAP to go away? J Hepatol 2017; 67(6):1324-31.

Budnitz DS, Lovegrove MC, Crosby AE. Emergency department visits for overdoses of acetaminophen-containing products. Am J Prev Med 2011; 40(6):585-92.

Herndon CM, Dankenbring DM. Patient perception and knowledge of acetaminophen in a large family medicine service. J Pain Palliat Care Pharmacother 2014; 28:109–16.

Clark R, Fisher JE, Sketris IS, Johnston GM. Population prevalence of high dose paracetamol in dispensed paracetamol/opioid prescription combinations: an observational study. BMC Clin Pharmacol 2012; 12:11.

Bunchorntavakul C, Reddy KR. Acetaminophen-related Hepatotoxicity. Clin Liver Dis 2013; 17:587– 607 .

Jaeschke H, McGill MR, Ramachandran A. Oxidant stress, mitochondria, and cell death mechanisms in drug-induced liver injury: lessons learned from acetaminophen hepatotoxicity. Drug Metab Rev 2012; 44:88–106.

Jaeschke H, McGill MR. Cytochrome P450-derived versus mitochondrial oxidant stress in acetaminophen hepatotoxicity. Toxicol Lett 2015; 235:216–17.

Castanares-Zapatero D, Dinant V, Ruggiano I, Willem H, Laterre PF, Hantson P. Pattern of Paracetamol Poisoning: Influence on Outcome and Complications. Toxics 2018; 6(4):58 .

Wiegand TJ, Margaretten M, Olson KR. Massive acetaminophen ingestion with early metabolic acidosis and coma: treatment with IV NAC and continuous venovenous hemodiafiltration. Clin Toxicol (Phila) 2010; 48(2):156–9.

Dart RC, Erdman AR, Olson KR, Christianson G, Manoguerra AS, Chyka PA, et al. Acetaminophen poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila) 2006; 44(1):1-18.

Liu ZX, Govindarajan S, Kaplowitz N. Innate immune system plays a critical role in determining the progression and severity of acetaminophen hepatotoxicity. Gastroenterology 2004; 127:1760–74 .

Xie Y, Ramachandran A, Breckenridge DG, Liles JT, Lebofsky M, Farhood A, et al. Inhibitor of apoptosis signal-regulating kinase 1 protects against acetaminophen-induced liver injury. Toxicol Appl Pharmacol 2015; 286:1–9.

Pettie JM, Caparrotta TM, Hunter RW, Morrison EE, Wood DM, Dargan PI, et al. Safety and Efficacy of the SNAP 12-hour Acetylcysteine Regimen for the Treatment of Paracetamol Overdose. EClinicalMedicine 2019; 11:11-7.

Downloads

Published

2022-04-30

How to Cite

Rawaz Mehdi Aziz Khoshnaw, Halgourd Fathulla Ahmed, & Karwan Yasin Mohamed. (2022). Paracetamol Poisoning Outcome at Rozhhalat Emergency Hospital- Erbil City. Academic Journal of Clinicians, 4(01), 15–31. Retrieved from https://clinician.site/index.php/ajcs/article/view/2