A 7-year experience of severe acetaminophen-induced hepatotoxicity (1987–1993)

Makin, Alistair; Wendon, Julia; Williams, Roger

doi:10.1016/0016-5085(95)90758-0

Cited by 289 publications

(202 citation statements)

References 29 publications

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“…Case reports (level 4), case series (level 4), and cohort (level 2b) or case-control (level 3b) studies have reported either greater severity of injury or a lower threshold dose for the development of hepatotoxicity after acetaminophen ingestion by patients chronically ingesting alcohol or other compounds thought to increase susceptibility to acetaminophen toxicity (e.g., isoniazid use, prolonged fasting) (2,34,(36)(37)(38)40,41,46,50,65,(67)(68)(69)(70)(71)(72). Evidence (level 4) indicating that a patient's alcoholic state does not contribute to outcome has also been reported (12,42).…”

Section: Repeated Supratherapeutic Ingestion (Rsti) By Patients 6 Yeamentioning

confidence: 98%

“…Studies (levels 2b and 4) have documented that there is poor correlation between the reported dose and either subsequent acetaminophen serum concentration or clinical outcome (31,42,43,(49)(50)(51)(52)(53). The correlation between reported dose and subsequent serum concentration or toxicity for children with unintentional ingestion is also poor (53)(54)(55).…”

Section: Acute Single Ingestions By Patients 6 Years Of Age and Oldermentioning

confidence: 99%

“…In another level-2b study, Bray et al (38) noted that survival was 67% in patients treated within 8-12 hours compared to 7% in untreated controls. In a level-2b study, Makin et al (42) showed that survival was better in patients treated with intravenous acetylcysteine within 24 hours (80%) and that patients treated after 24 hours were still more likely (78%) to survive than untreated controls (48%).…”

Section: Detoxification Of Acetaminophen Metabolite (Napqi)mentioning

confidence: 99%

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Acetaminophen Poisoning: an Evidence-Based Consensus Guideline for Out-of-Hospital Management

Dart

Erdman

Olson

et al. 2006

Clinical Toxicology

131

102

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The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and initial management of patients with suspected ingestions of acetaminophen. An evidencebased expert consensus process was used to create this guideline. This guideline applies to ingestion of acetaminophen alone and is based on an assessment of current scientific and clinical information.

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Section: Repeated Supratherapeutic Ingestion (Rsti) By Patients 6 Yeamentioning

confidence: 98%

Section: Acute Single Ingestions By Patients 6 Years Of Age and Oldermentioning

confidence: 99%

Section: Detoxification Of Acetaminophen Metabolite (Napqi)mentioning

confidence: 99%

See 1 more Smart Citation

Acetaminophen Poisoning: an Evidence-Based Consensus Guideline for Out-of-Hospital Management

Dart

Erdman

Olson

et al. 2006

Clinical Toxicology

131

102

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“…Increased ICP is a key event that defines their prognosis (Ascher et al, 1993;Hoofnagle et al, 1995;Makin et al, 1995;O'Grady et al, 1989;Trey and Davidson, 1970). Over 90% mortality is expected in patients with ALF in whom ICP cannot be controlled.…”

Section: Introductionmentioning

confidence: 99%

Hypothermia in Acute Liver Failure

Jalan

Rose

2004

Metab Brain Dis

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The development of encephalopathy in patients with acute liver injury defines the occurrence of liver failure. The encephalopathy of acute liver failure is characterized by brain edema which manifests clinically as increased intracranial pressure. Despite the best available medical therapies a significant proportion of patients with acute liver failure die due to brain herniation. The present review explores the experimental and clinical data to define the role of hypothermia as a treatment modality for increased intracranial pressure in patients with acute liver failure.

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“…To the best of our knowledge, except for those already experiencing fulminant hepatic failure, patients who will benefit from hospitalization for treatment with N-acetylcysteine (NAC) have not been defined. [7][8][9][10] To better understand the societal importance of acetaminophen-related injury, we sought to determine the frequency with which acute acetaminophen ingestion resulted in ED evaluation and hospitalization. We also sought the frequency of evaluation for chronic supratherapeutic use of acetaminophen.…”

mentioning

confidence: 99%

Population‐based Incidence and Outcome of Acetaminophen Poisoning by Type of Ingestion

Bond

Hite

1999

Academic Emergency Medicine

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Abstract. Objectives: 1) To determine, in a population-based sample, the observed frequency of acetaminophen overdose-related ED evaluation and hospitalization. 2) To examine the relative frequency of hospitalization by pattern of ingestion, the outcome of each group, and the presence or absence of postulated risk factors. Methods: This study was a 46-month, retrospective chart review of all acetaminophen-related visits, by patients at least 10 years of age, to either of the two hospitals that serve a fourcounty region of central Virginia. Results: Of 636 charts identified for review, only 137 involved acute or chronic acetaminophen overdose. One hundred twenty-six patients presented after an acute ingestion; 122 of these patients gave a history of a single, supratherapeutic ingestion of acetaminophen. Twenty-five patients were hospitalized for treatment. Eighteen of these were treated with N-acetylcysteine (NAC) based on the Rumack-Matthew nomogram; one suffered significant hepatic injury. The other seven presented at least 18 hours after ingestion, with no measurable serum acetaminophen. Two of these suffered significant hepatic injury. Four additional patients presented after multiple ingestions within 24 hours. Three were hospitalized, but none experienced significant injury. Only 11 patients were evaluated for chronic acetaminophen overmedication for pain (more than 6 g/day over a period of more than 24 hours). Four were admitted for treatment; three suffered significant hepatic injury. Thus, the observed incidence of acute acetaminophen ingestion in this region was 21.4/100,000/yr (95% CI = 17.7 to 25.2). The observed incidence of hospitalization for acute acetaminophen toxicity was 4.8/100,000/yr (95% CI = 3.0 to 6.5). The observed incidence of hospitalization for all acetaminophen poisoning was 5.5/100,000/yr (95% CI = 4.1 to 7.0). High ethanol consumption was present more frequently in those who suffered hepatic injury. Conclusions: Most patients evaluated for acetaminophen ingestion present early following acute single overdose. Relatively few of these patients require hospitalization and, for those hospitalized, the outcome is good. More significantly, acetaminophen overdose patients whose risk cannot be estimated using the Rumack-Matthew nomogram represented 44% of those hospitalized and 83% of those who suffered significant hepatic injury. Emergency physicians need to determine how they can impact the outcome of these patients. Efforts should be directed at further characterizing historical, physical, and biochemical markers of risk and at determining in which circumstances hospitalization for NAC or other therapies is justified.

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A 7-year experience of severe acetaminophen-induced hepatotoxicity (1987–1993)

Cited by 289 publications

References 29 publications

Acetaminophen Poisoning: an Evidence-Based Consensus Guideline for Out-of-Hospital Management

Acetaminophen Poisoning: an Evidence-Based Consensus Guideline for Out-of-Hospital Management

Hypothermia in Acute Liver Failure

Population‐based Incidence and Outcome of Acetaminophen Poisoning by Type of Ingestion

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