Comparison of assays for measuring plasma paracetamol

Jones, Anwen; Jarvie, D R; Simpson, David D.; Prescott, L. F.; Fitzpatrick, R. J.; Hassan, Tasneem M.; Ward, Victoria; Bodiwala, G.

doi:10.1136/bmj.316.7129.475a

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“…There are different methods of measuring serum paracetamol concentrations, which could be adopted. The common methods used in the estimation of paracetamol include use of immunoassay[ 8 ] High Performance Liquid Chromatography (HPLC),[ 9 ] Gas Liquid Chromatography (GLC),[ 10 ] and UV spectrophotometric methods. [ 11 12 ]…”

Section: Introductionmentioning

confidence: 99%

“…HPLC is considered as the preferred method for estimation of paracetamol due to its high sensitivity, precision, and freedom from interference. [ 8 ] Both HPLC and GLC cannot be widely adopted in resource-limited settings due to high capital expenditure on the purchase of the instrument, high running and maintenance costs, and the time taken for the procedure. The immunoassay method is used in private laboratories in Sri Lanka; however, the cost per test is considerable by local standards (US$18–22).…”

Section: Introductionmentioning

confidence: 99%

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A quick inexpensive laboratory method in acute paracetamol poisoning could improve risk assessment, management and resource utilization

et al. 2012

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Objectives:Acute paracetamol poisoning is an emerging problem in Sri Lanka. Management guidelines recommend ingested dose and serum paracetamol concentrations to assess the risk. Our aim was to determine the usefulness of the patient's history of an ingested dose of >150 mg/kg and paracetamol concentration obtained by a simple colorimetric method to assess risk in patients with acute paracetamol poisoning.Materials and Methods:Serum paracetamol concentrations were determined in 100 patients with a history of paracetamol overdose using High Performance Liquid Chromatography (HPLC); (reference method). The results were compared to those obtained with a colorimetric method. The utility of risk assessment by reported dose ingested and colorimetric analysis were compared.Results:The area under the receiver operating characteristic curve for the history of ingested dose was 0.578 and there was no dose cut-off providing useful risk categorization. Both analytical methods had less than 5% intra- and inter-batch variation and were accurate on spiked samples. The time from blood collection to result was six times faster and ten times cheaper for colorimetry (30 minutes, US$2) than for HPLC (180 minutes, US$20). The correlation coefficient between the paracetamol levels by the two methods was 0.85. The agreement on clinical risk categorization on the standard nomogram was also good (Kappa = 0.62, sensitivity 81%, specificity 89%).Conclusions:History of dose ingested alone greatly over-estimated the number of patients who need antidotes and it was a poor predictor of risk. Paracetamol concentrations by colorimetry are rapid and inexpensive. The use of these would greatly improve the assessment of risk and greatly reduce unnecessary expenditure on antidotes.

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