Paracetamol overdose: Relevance of recent evidence for managing patients in Sri Lanka

Galappatthy, Priyadarshani; Dawson, A.

doi:10.4038/cmj.v60i3.8184

Cited by 3 publications

(2 citation statements)

References 40 publications

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“…Since then, the incidence of poisoning has been increased, making paracetamol the most common drug in self-poisoning, with a high rate of morbidity and mortality in the world [4,5]. In Sri Lanka, the number of cases has been widely increased, to the extent of 50% of admissions related to poisoning at the National Hospital of Sri Lanka due to acetaminophen toxicity [6].…”

Section: Discussionmentioning

confidence: 99%

Acetaminophen Intoxication with Fulminant Hepatic Failure Salvaged by Plasmapheresis

Karunathilake¹,

Ranasinghe²,

Azher³

et al. 2021

IJCCR

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Introduction Acetaminophen-induced liver injury is the most common cause of acute liver failure, where multiple ingestions or a delay in the presentation may lead to a poor prognosis. N-acetylcysteine (NAC) is the conventional antidote used to treat acute acetaminophen toxicity, and plasmapheresis can be used as an adjunct, though there are no systematic studies to prove its effectivity. Case Presentation An 18-year-old girl was admitted with reduced responsiveness for one day with a few episodes of diarrhea. On admission, she was febrile and had a GCS of 10/15, otherwise normal neurology. She had marked right hypochodrial tenderness, deep icterus, and a pulse of 120 beats per minute, with a blood pressure of 80/50 mmHg; fluid resuscitation with inotropic support was done. Initial investigations revealed severe metabolic acidosis, hemoglobin of 9.5 g/dL, white blood cell count 13,500/mm3, and platelet 119,000 per µL. The prothrombin time (PT) international normalized ratio (INR) was 4.7, and the activated partial thromboplastin time (APTT) was 38.6. The alanine aminotransferase (ALT) level was 8118 U/L, and aspartate aminotransferase (AST) was 3883 U/L with a total bilirubin of 107 µmol/L. The diagnosis of acute liver failure following acetaminophen intoxication was made and managed with intravenous NAC, pantoprazole cover, intravenous ceftriaxone, metronidazole, thiamine, and vitamin K. Fresh frozen plasma and platelets were given for severe coagulopathy. She was started with plasmapheresis at the intensive care unit (ICU), where she had a significant improvement, though she developed hospital-acquired pneumonia, which was successfully managed. Subsequently, her liver functions returned to the baseline, and she was discharged after a psychiatric assessment. Conclusion A high degree of suspicion needs to be adopted to diagnose acetaminophen-induced acute liver failure when a patient presents with hepatic encephalopathy, and plasmapheresis can be considered a life-saving measure adjunct to the NAC.

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Section: Discussionmentioning

confidence: 99%

Acetaminophen Intoxication with Fulminant Hepatic Failure Salvaged by Plasmapheresis

Karunathilake¹,

Ranasinghe²,

Azher³

et al. 2021

IJCCR

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“…Acute liver failure can occur through toxins, drugs or pathogenic infections. 1 Excess alcohol consumption 2 and acetaminophen (APAP) overdose 3 are common causes of liver damage. In such cases, oxidative stress caused by reactive oxygen species (ROS) and reactive nitrogen species (RNS) leads to the oxidation of cellular macromolecules, causing liver damage.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Mesenchymal Stem Cell-derived Hepatocyte-like Cells and HepG2 Cells for Use in Drug-Induced Liver Injury Studies

2022

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Liver cell lines obtained from hepatomas, for example, HepG2 cells, are commonly used in drug toxicity studies. However, functional hepatocyte-like cells derived from mesenchymal stem cells (MSCs) could be a better option for use in the study of drug metabolism and toxicity. Overdose of acetaminophen (APAP) and excess alcohol consumption are common causes of liver damage. The objective of the present study was to investigate the use of MSC-derived hepatocyte-like cells (MSCdH) in the assessment of drug-induced liver injury (by using APAP and ethanol), and to compare the toxic effects observed in the MSCdH with those exhibited by HepG2 cells. MSCs were isolated from umbilical cord and their functionality confirmed by their ability to differentiate into adipocytes, osteocytes and hepatocyte-like cells. It was shown that the MSCs successfully differentiated into hepatocyte-like cells, and these cells were further characterised by using various enzyme assays and by assessing albumin secretion and urea synthesis. Cytotoxicity was evaluated in the HepG2 and MSCdH after exposure to ethanol and APAP, with cell viability being determined by using the MTT assay. After exposure to ethanol and to APAP, cell viability decreased in a concentration-dependent manner for both types of hepatocytes. The respective EC50 values of ethanol-induced toxicity for HepG2 and MSCdH cells were 2.5% and 1.3% v/v ( p < 0.001); for APAP-induced toxicity they were 19.1 mM and 12.6 mM ( p < 0.001). These findings show that there is a distinct difference between the two types of hepatocytes in terms of APAP-induced and ethanol-induced liver injury.

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Assessment of Hepatoprotective and Antiulcer Activity of Launaea aspleniifolia Hook in Laboratory Animals

Ali¹,

AnupMaiti²,

Vishwakarma³

et al. 2020

CBC

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Background: Launaea aspleniifolia Hook (Family Asteraceae) is used traditionally in medicine in Indian system for the treatment of leucoderma. This study was conducted to evaluate the hepatoprotective and antiulcer effects using the methanolic extract of Launaea aspleniifolia Hook (MELA). Methods: The MELA in the dose of 200 and 400 mg/kg body weight (b.w.) was administered orally, daily for 7 days to prevent the acetaminophen-induced hepatotoxicity and peptic ulcer. In order to determine the antioxidant enzymes activity, various enzymatic parameters including alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBL), direct bilirubin (DBL), alkaline phosphatase (ALP), total protein (TP), albumin (ALB), high density lipoproteins (HDL), random glucose test (RBS), serum creatinine levels (SCL) and direct bilirubin (DBL) were determined. Further, the histopathology of tissue and various gastric secretion parameters like free acidity, total acidity ulcer score, % ulcer inhibition, gastric volume, pH, Na+ and K+ and histopathology were determined in PLinduced ulcer model. Results: MELA showed dose-dependent hepatoprotective and ulcer protective effect in acetaminopheninduced hepatotoxicity and antiulcer activity. Furthermore, tissue antioxidant parameter such as reduced Malondialdehyde (MDA), histopathology was also investigated. MELA was more potent in controlling all the serological parameter of liver like ALT, AST, TBL, DBL, ALP, HDL, RBS, SCL, TP and ALB in a dose-dependent manner (P<0.05) induced by Acetaminophen. Apart from this, antiulcer activity MELA was confirmed by the low level of ulcer index along with the reduction of free acidity, total acidity ulcer score, % ulcer inhibition, gastric volume, Na+ and an increase K+, pH of gastric content in a dose-dependent manner (P<0.05) induced PL model. Conclusion: The results indicated a significant dose-dependent effect of MELA from injuries induced in liver and stomach. These protective effects of MELA can be examined in various other toxicities as alone and in combinations.

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Paracetamol overdose: Relevance of recent evidence for managing patients in Sri Lanka

Cited by 3 publications

References 40 publications

Acetaminophen Intoxication with Fulminant Hepatic Failure Salvaged by Plasmapheresis

Acetaminophen Intoxication with Fulminant Hepatic Failure Salvaged by Plasmapheresis

A Comparison of Mesenchymal Stem Cell-derived Hepatocyte-like Cells and HepG2 Cells for Use in Drug-Induced Liver Injury Studies

Assessment of Hepatoprotective and Antiulcer Activity of Launaea aspleniifolia Hook in Laboratory Animals

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