Concomitant overdosing of other drugs in patients with paracetamol poisoning

Abstract

Aims Paracetamol is frequently involved in intended self‐poisoning, and concomitant overdosing of other drugs is commonly reported. The purpose of the study was to investigate further concomitant drug overdose in patients with paracetamol poisoning and to evaluate its effects on the outcome of the paracetamol intoxication. Methods Six hundred and seventy‐one consecutive patients admitted with paracetamol poisoning were studied and concomitant drug intake was recorded. The relative risk of hepatic encephalopathy, death or liver transplantation, hepatic dysfunction, liver cell damage, and renal dysfunction associated with concomitant overdosing of other drugs was evaluated by multivariate analysis. Results Concomitant drug overdose was found in 207 patients (31%, 95% confidence interval [CI] 27, 34%). Concomitant overdosing of benzodiazepines (99 cases), opioid analgesics (38 cases), acetylsalicylic acid (33 cases), and NSAID (32 cases) predominated. Concomitant benzodiazepine overdose was an independent risk factor in the development of hepatic encephalopathy (odds ratio [OR] 1.91; CI 1.00, 3.65) and renal dysfunction (OR 1.81; CI 1.00, 3.22). Concomitant overdosing of opioid analgesics was a protective factor in the development of hepatic encephalopathy (OR 0.26; CI 0.07, 0.96). Concomitant acetylsalicylic acid overdose was a risk factor in the development of hepatic encephalopathy (OR 4.87; CI 1.52, 15.7) and death or liver transplantation (OR 6.04; CI 1.69, 21.6). A tendency towards a more favourable outcome was observed in patients with concomitant NSAID overdose. Conclusions Concomitant overdosing of benzodiazepines or analgesics is frequent in patients admitted with paracetamol poisoning. Concomitant benzodiazepine or acetylsalicylic acid overdose was associated with more severe toxicity, whereas concomitant overdosing of opioid analgesics was associated with less toxicity.

Hyperamylasaemia and acute pancreatitis in paracetamol poisoning

“…Increasing degrees of hyperamylasaemia were significantly associated with a higher age, a longer ‘time to NAC’, a higher incidence of chronic alcohol abuse, and a lower incidence of acute alcohol ingestion (Table 1). A multiple regression analysis using serum amylase as the dependent variable and known or suspected risk factors of paracetamol‐induced hepatotoxicity (age, sex, quantity of paracetamol, ‘time to NAC’, chronic alcohol abuse, acute alcohol ingestion, acetylsalicylic acid co‐overdosing, benzodiazepine co‐overdosing and opioid co‐overdosing) as independent variables was performed 26, 27 . This analysis confirmed age, chronic alcohol abuse, and ‘time to NAC’ as independent risk factors of an elevated serum amylase, whereas acute alcohol ingestion was a protective factor.…”

Acute Liver Failure

“…Acetaminophen toxicity does not inevitably lead to ALF, but various risk factors increase the probability of acute liver damage even at "therapeutic doses" (e.g., 45 g daily). Comorbidity and/or the intake of other substances increase the risk of liver failure after consumption of acetaminophen (10), as does alcohol (11). Furthermore, there are indications that certain genetic polymorphisms favor toxic liver damage (12, e6).…”

The effect of regular medication on the outcome of paracetamol poisoning

“…Each of the predominant types of regular medication were used as independent variables, together with known or suspected risk factors in paracetamol poisoning (age, gender, quantity of paracetamol, ‘time to N ‐acetylcysteine’, chronic alcohol abuse and acute co‐ingestion of alcohol) and concomitant overdosing of other drugs suggested to affect the outcome of paracetamol poisoning (benzodiazepines, opioid analgesics, acetylsalicylic acid and non‐steroidal anti‐inflammatory drugs) 19 ,. 20 Odds ratios (OR) are given with 95% confidence intervals (95% CI) using Simes' modification of the Bonferroni method to correct for multiple testing.…”