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Clinical Research

Plasma paracetamol concentration at hospital presentation has a dose-dependent relationship with liver injury despite prompt treatment with intravenous acetylcysteine

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Pages 405-410 | Received 08 Nov 2015, Accepted 22 Feb 2016, Published online: 25 Apr 2016

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Read on this site (10)

Angela L. Chiew & Geoffrey K. Isbister. (2023) Advances in the understanding of acetaminophen toxicity mechanisms: a clinical toxicology perspective. Expert Opinion on Drug Metabolism & Toxicology 0:0, pages 1-16.
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Ari B. Filip, Sarah E. Berg, Michael E. Mullins & Evan S. Schwarz. (2022) Fomepizole as an adjunctive therapy for acetaminophen poisoning: cases reported to the toxicology investigators consortium (ToxIC) database 2015–2020. Clinical Toxicology 60:9, pages 1006-1011.
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D. Nicholas Bateman, James W. Dear, Michael Eddleston & J. Allister Vale. (2022) Comment on Fomepizole as an adjunct in acetylcysteine treated acetaminophen overdose patients: a case series. Clinical Toxicology 60:5, pages 666-667.
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Naura Syafira, Andis Graudins, Mark Yarema & Anselm Wong. (2022) Comparing development of liver injury using the two versus three bag acetylcysteine regimen despite early treatment in paracetamol overdose. Clinical Toxicology 60:4, pages 478-485.
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John W. Downs, Kirk L. Cumpston, Emily K. Kershner, Michelle M. Troendle, S. Rutherfoord Rose & Brandon K. Wills. (2021) Clinical outcome of massive acetaminophen overdose treated with standard-dose N-acetylcysteine. Clinical Toxicology 59:10, pages 932-936.
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Angela L. Chiew, Genaro Domingo, Nicholas A. Buckley, Paul Stathakis, Kirsty Ress & Darren M. Roberts. (2020) Hepatotoxicity in a child following an accidental overdose of liquid paracetamol. Clinical Toxicology 58:11, pages 1063-1066.
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Robert G. Hendrickson. (2019) What is the most appropriate dose of N-acetylcysteine after massive acetaminophen overdose?. Clinical Toxicology 57:8, pages 686-691.
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Anselm Wong, Marco L. A. Sivilotti, Naren Gunja, Richard McNulty & Andis Graudins. (2018) Accuracy of the paracetamol-aminotransferase product to predict hepatotoxicity in paracetamol overdose treated with a 2-bag acetylcysteine regimen. Clinical Toxicology 56:3, pages 182-188.
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Angela L. Chiew, Geoffrey K. Isbister, Katharine A. Kirby, Colin B. Page, Betty S. H. Chan & Nicholas A. Buckley. (2017) Massive paracetamol overdose: an observational study of the effect of activated charcoal and increased acetylcysteine dose (ATOM-2). Clinical Toxicology 55:10, pages 1055-1065.
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Anselm Wong & Andis Graudins. (2017) Risk prediction of hepatotoxicity in paracetamol poisoning. Clinical Toxicology 55:8, pages 879-892.
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Articles from other publishers (42)

Nafiseh Alizadeh, Amir‐Mohammad Yaryari, Amir Hossein Behnoush, Kosar Raoufinejad & Behnam Behnoush. (2023) Late N ‐acetylcysteine for successful recovery of acetaminophen‐related acute liver failure: A case report . Clinical Case Reports 11:9.
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A. Yu. Simonova, M. M. Potskhveriya, M. V. Belova, K. K. Ilyashenko, V. V. Kulabukhov & L. R. Asanova. (2023) Comparative evaluation of the effectiveness and safety of 12-hour and 21-hour protocols for the administration of acetylcysteine in paracetamol poisoning. Messenger of ANESTHESIOLOGY AND RESUSCITATION 20:4, pages 46-53.
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Angela L. Chiew, Geoffrey K. Isbister, Paul Stathakis, Katherine Z. Isoardi, Colin Page, Kirsty Ress, Betty S.H. Chan & Nicholas A. Buckley. (2023) Acetaminophen Metabolites on Presentation Following an Acute Acetaminophen Overdose ( ATOM ‐7) . Clinical Pharmacology & Therapeutics 113:6, pages 1304-1314.
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Xiaolei Miao, Chengting Jin, Jiao Liu, Junjun Wang & Yong Chen. (2023) Honokiol attenuates acetaminophen-induced acute liver injury by inhibiting hepatic CYP1A2 activity and improving liver mitochondrial dysfunction. Chinese Herbal Medicines 15:2, pages 231-239.
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James W. Dear. (2022) Fomepizole should not be used more liberally in paracetamol overdose. British Journal of Clinical Pharmacology 89:2, pages 599-601.
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Ari B. Filip & Michael E. Mullins. (2022) Fomepizole should be used more liberally in paracetamol overdose. British Journal of Clinical Pharmacology 89:2, pages 594-598.
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D. Nicholas Bateman. (2022) Large paracetamol overdose—Higher dose acetylcysteine is required. British Journal of Clinical Pharmacology 89:1, pages 34-38.
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H. K. Ruben Thanacoody. (2022) Large paracetamol overdose – Higher dose NAC is NOT required. British Journal of Clinical Pharmacology 89:1, pages 39-42.
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A. Yu. Simonova, M. M. Potskhveriya, M. V. Belova, K. K. Ilyashenko, V. V. Kulabuhov, N. Y. Stolbova & A. E. Klyuev. (2022) On the Treatment of Acute Poisoning With Paracetamol. Russian Sklifosovsky Journal "Emergency Medical Care" 11:2, pages 249-257.
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Kenzo Motohashi & Ruben HK Thanacoody. (2022) Toxicology in the emergency department: what's new?. British Journal of Hospital Medicine 83:9, pages 1-16.
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Huiling Tan, Paul Stathakis, Benoj Varghese, Nicholas A. Buckley & Angela L. Chiew. (2022) Delayed Acetaminophen Absorption Resulting in Acute Liver Failure. Case Reports in Critical Care 2022, pages 1-6.
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Sasha K. Kaiser & Richard C. Dart. (2022) The Roles of Antidotes in Emergency Situations. Emergency Medicine Clinics of North America 40:2, pages 381-394.
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Halima Amer, John R. H. Archer, Kerry Layne, Alison M. Dines, David M. Wood, Shaun L. Greene & Paul I. Dargan. (2021) Paracetamol toxicity in mild overdose in combination with opioids: A retrospective observational study. British Journal of Clinical Pharmacology 88:3, pages 1258-1267.
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Ali Mohammad Pourbagher-Shahri, Jonathan Schimmel, Farshad M. Shirazi, Samaneh Nakhaee & Omid Mehrpour. (2022) Use of fomepizole (4-methylpyrazole) for acetaminophen poisoning: A scoping review. Toxicology Letters 355, pages 47-61.
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Jephte Y. Akakpo, Anup Ramachandran, Steven C. Curry, Barry H. Rumack & Hartmut Jaeschke. (2022) Comparing N-acetylcysteine and 4-methylpyrazole as antidotes for acetaminophen overdose. Archives of Toxicology 96:2, pages 453-465.
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Summon Chomchai, Pattaraporn Mekavuthikul, Jariya Phuditshinnapatra & Chulathida Chomchai. (2022) Sensitivity of dose‐estimations for acute acetaminophen overdose in predicting hepatotoxicity risk using the Rumack‐Matthew Nomogram. Pharmacology Research & Perspectives 10:1.
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A. H. Shntaif, N. A. Alrazzak, A. Bader & A. M. Almarzoqi. (2021) Determination the binding ability of N-acetyl cysteine and its derivatives with SARS-COV-2 main protease using molecular docking and molecular dynamics studies. The Ukrainian Biochemical Journal 93:5, pages 43-51.
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Michael H. Chiu, Natalia Jaworska, Nicholas L. Li & Mark Yarema. (2021) Massive Acetaminophen Overdose Treated Successfully with N-Acetylcysteine, Fomepizole, and Hemodialysis. Case Reports in Critical Care 2021, pages 1-5.
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Angela L. Chiew & Nicholas A. Buckley. (2021) Acetaminophen Poisoning. Critical Care Clinics 37:3, pages 543-561.
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UmarMuhammad Tukur & ShaibuOricha Bello. (2021) Gender variations in pharmacokinetics of paracetamol in hausa/fulani ethnic group in Northwest Nigeria – A two-stage approach. International Journal of Applied and Basic Medical Research 11:4, pages 248.
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Kristen M. Audley & Jamie M. Rosini. (2020) Increased Intravenous N-Acetylcysteine Dosing Following Massive Acetaminophen Ingestion: A Case Report. Journal of Emergency Nursing 46:3, pages 359-363.
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A. Min Kang, Angela Padilla-Jones, Erik S. Fisher, Jephte Y. Akakpo, Hartmut Jaeschke, Barry H. Rumack, Richard D. Gerkin & Steven C. Curry. (2019) The Effect of 4-Methylpyrazole on Oxidative Metabolism of Acetaminophen in Human Volunteers. Journal of Medical Toxicology 16:2, pages 169-176.
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Angela L Chiew, David Reith, Adam Pomerleau, Anselm Wong, Katherine Z Isoardi, Jessamine Soderstrom & Nicholas A Buckley. (2019) Updated guidelines for the management of paracetamol poisoning in Australia and New Zealand. Medical Journal of Australia 212:4, pages 175-183.
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Angela L. Chiew, Laura P. James, Geoffrey K. Isbister, John W. Pickering, Kylie McArdle, Betty S.H. Chan & Nicholas A. Buckley. (2020) Early acetaminophen-protein adducts predict hepatotoxicity following overdose (ATOM-5). Journal of Hepatology 72:3, pages 450-462.
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Anselm Wong, Geoff Isbister, Richard McNulty, Katherine Isoardi, Keith Harris, Angela Chiew, Shaun Greene, Naren Gunja, Nicholas Buckley, Colin Page & Andis Graudins. (2020) Efficacy of a two bag acetylcysteine regimen to treat paracetamol overdose (2NAC study). EClinicalMedicine 20, pages 100288.
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Rose Cairns, Jared A Brown, Claire E Wylie, Andrew H Dawson, Geoffrey K Isbister & Nicholas A Buckley. (2019) Paracetamol poisoning‐related hospital admissions and deaths in Australia, 2004–2017. Medical Journal of Australia 211:5, pages 218-223.
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Timon Geib, Cristina Lento, Derek J. Wilson & Lekha Sleno. (2019) Liquid Chromatography-Tandem Mass Spectrometry Analysis of Acetaminophen Covalent Binding to Glutathione S-Transferases. Frontiers in Chemistry 7.
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D. Nicholas Bateman & James W. Dear. (2019) Acetylcysteine in paracetamol poisoning: a perspective of 45 years of use. Toxicology Research 8:4, pages 489-498.
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Janice M. Pettie, Thomas M. Caparrotta, Robert W. Hunter, Emma E. Morrison, David M. Wood, Paul I. Dargan, Ruben H. Thanacoody, Simon H.L. Thomas, Muhammad E.M.O. Elamin, Ben Francis, David J. Webb, Euan A. Sandilands, Michael Eddleston & James W. Dear. (2019) Safety and Efficacy of the SNAP 12-hour Acetylcysteine Regimen for the Treatment of Paracetamol Overdose. EClinicalMedicine 11, pages 11-17.
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Dilin Tang, Wui Ling Chan & Dong Haur Phua. (2018) Performance of an emergency department observation unit protocol in reducing length of stay for acetaminophen overdose: a retrospective study. International Journal of Emergency Medicine 11:1.
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Diego Castanares-Zapatero, Valérie Dinant, Ilaria Ruggiano, Harold Willem, Pierre-François Laterre & Philippe Hantson. (2018) Pattern of Paracetamol Poisoning: Influence on Outcome and Complications. Toxics 6:4, pages 58.
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Timon Geib, André LeBlanc, Tze Chieh Shiao, René Roy, Elaine M. Leslie, Constantine J. Karvellas & Lekha Sleno. (2018) Absolute quantitation of acetaminophen-modified human serum albumin in acute liver failure patients by liquid chromatography/tandem mass spectrometry. Rapid Communications in Mass Spectrometry 32:17, pages 1573-1582.
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Nora Freyer, Selina Greuel, Fanny Knöspel, Florian Gerstmann, Lisa Storch, Georg Damm, Daniel Seehofer, Jennifer Foster Harris, Rashi Iyer, Frank Schubert & Katrin Zeilinger. (2018) Microscale 3D Liver Bioreactor for In Vitro Hepatotoxicity Testing under Perfusion Conditions. Bioengineering 5:1, pages 24.
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Angela L Chiew, Christian Gluud, Jesper Brok & Nick A Buckley. (2018) Interventions for paracetamol (acetaminophen) overdose. Cochrane Database of Systematic Reviews 2018:2.
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James W Dear, Joanna I Clarke, Ben Francis, Lowri Allen, Jonathan Wraight, Jasmine Shen, Paul I Dargan, David Wood, Jamie Cooper, Simon H L Thomas, Andrea L Jorgensen, Munir Pirmohamed, B Kevin Park & Daniel J Antoine. (2018) Risk stratification after paracetamol overdose using mechanistic biomarkers: results from two prospective cohort studies. The Lancet Gastroenterology & Hepatology 3:2, pages 104-113.
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Anselm Wong, Cornelia B. Landersdorfer & Andis Graudins. (2017) In reply. European Journal of Clinical Pharmacology 74:2, pages 253-253.
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Elie Harmouche, Mary Ann Howland & Mark K Su. (2017) In response to: “Pharmacokinetic modelling of modified acetylcysteine infusion regimens used in the treatment of paracetamol poisoning”. European Journal of Clinical Pharmacology 74:2, pages 251-251.
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Summon Chomchai & Chulathida Chomchai. (2018) Being overweight or obese as a risk factor for acute liver injury secondary to acute acetaminophen overdose. Pharmacoepidemiology and Drug Safety 27:1, pages 19-24.
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D. Nicholas Bateman & James W. Dear. (2017) Should we treat very large paracetamol overdose differently?. British Journal of Clinical Pharmacology 83:6, pages 1163-1165.
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Daniel J. B. Marks, Paul I. Dargan, John R. H. Archer, Charlotte L. Davies, Alison M. Dines, David M. Wood & Shaun L. Greene. (2017) Outcomes from massive paracetamol overdose: a retrospective observational study. British Journal of Clinical Pharmacology 83:6, pages 1263-1272.
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ADB Vliegenthart, RA Kimmitt, JH Seymour, NZ Homer, JI Clarke, M Eddleston, A Gray, DM Wood, PI Dargan, JG Cooper, DJ Antoine, DJ Webb, SC Lewis, DN Bateman & JW Dear. (2016) Circulating acetaminophen metabolites are toxicokinetic biomarkers of acute liver injury. Clinical Pharmacology & Therapeutics 101:4, pages 531-540.
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Gabriela Corcoran, Betty Chan & Angela Chiew. (2016) Use and knowledge of single dose activated charcoal: A survey of Australian doctors. Emergency Medicine Australasia 28:5, pages 578-585.
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