Paracetamol-associated coma, metabolic acidosis, renal and hepatic failure

Kritharides, L.; Fassett, Robert G.; Singh, Baljeet

doi:10.1007/bf00262905

Cited by 6 publications

(3 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Other substances such as ethanol [47] and propylene glycol [48] may cause lactic acidosis in large doses, but paracetamol was the sole drug ingested in just over half of the cases listed in Table 1, as confirmed by toxicology analysis [6,7,33,[36][37][38]46]. Three patients experienced hypoglycaemia [37,39], which may have been due to inhibition of gluconeogenesis by paracetamol. Eight patients (33%) were treated with intravenous bicarbonate (100 to 400 mmol) and more than half required intubation and ventilation for significant respiratory depression.…”

Section: Early Lactic Acidosis and Paracetamol Poisoningmentioning

confidence: 93%

“…In addition, nine of the 24 cases were treated with haemofiltration, haemodialysis or haemoperfusion to aid the removal of paracetamol or for treatment of renal failure [33–39, 43, 46]. Paracetamol and its metabolites have a large volume of distribution, so extracorporeal methods do not significantly increase overall total body clearance [64].…”

Section: Management Of Early Lactic Acidosis In Paracetamol Poisoningmentioning

confidence: 99%

“…We found 24 case reports of patients presenting with an early lactic acidosis (or metabolic acidosis with no other apparent cause) after massive paracetamol ingestion (summarized in Table 1) [6, 7, [33][34][35][36][37][38][39][40][41][42][43][44][45][46]. These patients typically presented with a reduced conscious level early after paracetamol ingestion (median 5 h), with a very high plasma paracetamol concentration (maximum 1614 mg l -1 , median 844 mg l -1 ) and a metabolic acidosis with high arterial or venous lactate on presentation.…”

Section: Early Lactic Acidosis and Paracetamol Poisoningmentioning

confidence: 99%

See 2 more Smart Citations

Understanding lactic acidosis in paracetamol (acetaminophen) poisoning

Shah

Wood

2010

Brit J Clinical Pharma

View full text Add to dashboard Cite

Paracetamol (acetaminophen) is one of the most commonly taken drugs in overdose in many areas of the world, and the most common cause of acute liver failure in both the UK and USA. Paracetamol poisoning can result in lactic acidosis in two different scenarios. First, early in the course of poisoning and before the onset of hepatotoxicity in patients with massive ingestion; a lactic acidosis is usually associated with coma. Experimental evidence from studies in whole animals, perfused liver slices and cell cultures has shown that the toxic metabolite of paracetamol, N‐acetyl‐p‐benzo‐quinone imine, inhibits electron transfer in the mitochondrial respiratory chain and thus inhibits aerobic respiration. This occurs only at very high concentrations of paracetamol, and precedes cellular injury by several hours. The second scenario in which lactic acidosis can occur is later in the course of paracetamol poisoning as a consequence of established liver failure. In these patients lactate is elevated primarily because of reduced hepatic clearance, but in shocked patients there may also be a contribution of peripheral anaerobic respiration because of tissue hypoperfusion. In patients admitted to a liver unit with paracetamol hepatotoxicity, the post‐resuscitation arterial lactate concentration has been shown to be a strong predictor of mortality, and is included in the modified King's College criteria for consideration of liver transplantation. We would therefore recommend that post‐resuscitation lactate is measured in all patients with a severe paracetamol overdose resulting in either reduced conscious level or hepatic failure.

show abstract

Section: Early Lactic Acidosis and Paracetamol Poisoningmentioning

confidence: 93%

Section: Management Of Early Lactic Acidosis In Paracetamol Poisoningmentioning

confidence: 99%

Section: Early Lactic Acidosis and Paracetamol Poisoningmentioning

confidence: 99%

See 1 more Smart Citation

Understanding lactic acidosis in paracetamol (acetaminophen) poisoning

Shah

Wood

2010

Brit J Clinical Pharma

View full text Add to dashboard Cite

show abstract

Renal Effects of Over‐the‐Counter Analgesics

Whelton

1995

The Journal of Clinical Pharma

View full text Add to dashboard Cite

Recent case reports have shown that over-the-counter (OTC) analgesics, which are generally considered to be a safe treatment for minor aches and pains and fever, may cause adverse renal effects. Many renal syndromes induced by nonsteroidal antiinflammatory drugs (NSAIDs) can be attributed to prostaglandin inhibition. Fluid and electrolyte disturbances, acute renal failure, and acute interstitial nephritis also occur predominantly with NSAIDs. Acetaminophen lacks significant peripheral prostaglandin inhibition and may be a preferred first-line agent, particularly in patients susceptible to the induction of renal impairment. Apart from obvious clinical overdosage situations, limited reports of adverse renal effects exist with acetaminophen. Some studies have reported an association between analgesic nephropathy, one of the most severe analgesic-related adverse renal effects, and long-term abuse of phenacetin, acetaminophen, aspirin, ibuprofen, analgesic combinations, or other NSAIDs, although for some of these agents, this relationship is controversial. The overall risk for serious renal effects with OTC analgesics appears to be low, but given the accessibility and vast number of persons taking these agents, the absolute number of patients affected may be substantial. Therefore, it is important that healthcare providers recognize the risk factors for adverse analgesic-related renal effects.

show abstract

Himidification of dry inspired gases

1989

Intensive Care Med

View full text Add to dashboard Cite

Paracetamol-associated coma, metabolic acidosis, renal and hepatic failure

Cited by 6 publications

References 2 publications

Understanding lactic acidosis in paracetamol (acetaminophen) poisoning

Understanding lactic acidosis in paracetamol (acetaminophen) poisoning

Renal Effects of Over‐the‐Counter Analgesics

Himidification of dry inspired gases

Contact Info

Product

Resources

About