Acetaminophen citations
Acetaminophen (Panadol,
Paracetamol, Calpol, Salzone, Tylenol)
Citations
Acetaminophen can cause serious damage to liver cells and tissues when an
overdose is taken or it is used in combination with alcohol. In 1996 alone, 74,000 cases
of acetaminophen toxicity were reported in the United States, according to United States
Poison Control Centers figures.
Yang
CC, Deng JF, Lin TJ. Pancytopenia, hyperglycemia, shock, coma,
rhabdomyolysis, and pancreatitis associated with acetaminophen poisoning.Vet Hum Toxicol. 2001 Dec;43(6):344-8.PMID: 11757993 [PubMed - indexed for
MEDLINE]
It is well recognized that acetaminophen overdose can cause severe hepatic injury.
However, extra-hepatic manifestations may also develop following inappropriate use or
ingestion of large amounts of acetaminophen. We present a 44-y-o female who manifested
coma, metabolic acidosis, shock, hypothermia, hyperglycemia, rhabdomyolysis,
hepatotoxicity, and renal insufficiency after suicidal ingestion of an unknown amount of
acetaminophen. Although her consciousness and hemodynamic status gradually improved after
treatment with N-acetylcysteine and other supportive measures, she was found to have
pancytopenia, pancreatitis and hepatorenal failure during the hospitalization and
eventually died 18 d post-admission. Review of relevant literature reports and the
clinical findings in our patient suggests that direct toxic effects mediated by
acetaminophen or its metabolites were most likely responsible for most of the observed
clinical features.
Ranganathan
SS, Fernandopulle BM, de Silva MV, Fernandopulle M.Fulminant heptic
failure in a child following paracetamol overdosing.Ceylon Med J.
2001 Jun;46(2):72-3. No abstract available.PMID: 11727585 [PubMed - indexed for MEDLINE]
Stevenson
R, MacWalter RS, Harmse JD, Wilson E. Mortality during the winter
flu epidemic--two cases of death associated with self-medication.Scott
Med J. 2001 Jun;46(3):84-6.PMID: 11501327 [PubMed - indexed for MEDLINE]
We report two cases of mortality associated with the recent winter influenza
outbreak. Both cases were associated with self-medication. In one case an elderly lady
died from haemorrhagic duodenitis induced by over the counter ibuprofen. In the second
case the lady died from the consequences of exceeding the recommended doses of paracetamol
by combining doses of the generic product with proprietary flu-remedies and Tylex
(paracetamol and codeine).
- Cerebral edema with herniation during acetaminophen-induced fulminant hepatic failure.
Liver Transpl. 2000 Jul;6(4):495-6. No abstract available.
PMID: 10915174 [PubMed - indexed for MEDLINE]
- Anaphylactoid reactions to paracetamol.
Postgrad Med J. 2000 Aug;76(898):501-2.
PMID: 10908380 [PubMed - indexed for MEDLINE]
- Early metabolic acidosis and coma after acetaminophen ingestion.
Ann Emerg Med. 1999 Apr;33(4):452-6.
PMID: 10092726 [PubMed - indexed for MEDLINE]
Metabolic acidosis and coma may develop in patients who experience severe hepatic injury
after acetaminophen poisoning. The onset of acidosis and coma soon after acetaminophen
overdose, but preceding manifest hepatic injury, contrasts with the typical course of
poisoning. This pattern has been reported in a limited number of cases. Coingestions and
the rare occurrence of these findings after an overdose have engendered controversy as to
whether acetaminophen alone is the cause of early coma and acidosis. We describe 4
separate overdoses among 3 patients who arrived at the emergency department comatose with
a metabolic acidosis soon after ingesting large amounts of acetaminophen without evidence
of toxic liver injury. Our cases support the view that early metabolic acidosis with coma
does indeed occur after acetaminophen poisoning, independent of hepatic failure or its
complications.
- Acetaminophen poisoning and liver function.
N Engl J Med. 1994 Nov 10;331(19):1311; discussion 1311-2. No abstract
available.
PMID: 7935695 [PubMed - indexed for MEDLINE]
- Paracetamol-induced acute pancreatitis.
Br Med J. 1977 Mar 19;1(6063):753-4. No abstract available.
PMID: 851712 [PubMed - indexed for MEDLINE]
- Acetaminophen poisoning.
N C Med J. 1981 Sep;42(9):665-6. No abstract available.
PMID: 6946298 [PubMed - indexed for MEDLINE]
- Hemorrhagic pancreatitis associated with acetaminophen overdose.
Am J Gastroenterol. 1986 Jul;81(7):579-82.
- Liver failure induced by paracetamol.
BMJ. 1993 Mar 13;306(6879):717-8. No abstract available.
PMID: 8333876 [PubMed - indexed for MEDLINE]
- Acetaminophen poisoning and liver function.
N Engl J Med. 1994 Nov 10;331(19):1311-2. No abstract available
- Metabolic acidosis and coma following a severe acetaminophen overdose.
Ann Pharmacother. 1999 Nov;33(11):1191-4.
PMID: 10573319 [PubMed - indexed for MEDLINE]
- Acute acetaminophen overdose in adolescents and adults.
Crit Care Nurse. 2000 Jun;20(3):69-74. Review. No abstract available.
PMID: 11876216 [PubMed - indexed for MEDLINE]
- [Acute paracetamol and aspirin poisoning]
Rev Prat. 1997 Apr 1;47(7):736-41. French.
PMID: 9183950 [PubMed - indexed for MEDLINE]
- Renal abuse from non-steroidal, anti-inflammatory agents in sport.
N Z Med J. 1998 Mar 27;111(1062):107-8. No abstract available.
PMID: 9577467 [PubMed - indexed for MEDLINE]
- [Paracetamol poisoning]
Ugeskr Laeger. 1984 Dec 17;146(51):4030-3. Danish. No abstract available.
PMID: 6523605 [PubMed - indexed for MEDLINE]
- Liver failure induced by paracetamol.
BMJ. 1993 Mar 13;306(6879):717. No abstract available.
PMID: 8329027 [PubMed - indexed for MEDLINE]
- Acetaminophen poisoning in late pregnancy. A case report.
J Reprod Med. 1997 Jun;42(6):367-71.
PMID: 9219126 [PubMed - indexed for MEDLINE]
BACKGROUND: Acetaminophen poisoning is a major cause of hospital admission and has
been extensively reviewed. Its occurrence in pregnant women has been reported seldom, and
the prognosis has been good except for one case, in which the fetus died. We report on a
case of acetaminophen poisoning that resulted in the death of both the mother and the
infant. CASE: A 38-year-old woman whose pregnancy was at 31 weeks' gestational age was
evaluated for treatment of an acetaminophen overdose. She was admitted more than 26 hours
after taking 35 g of acetaminophen. An emergency cesarean section was performed one hour
after admission because of acute fetal distress. A grossly normal, 1,620-g, female infant
was delivered and had Apgar scores at 1, 5 and 10 minutes of 0, 0 and 1, respectively,
despite the initiation of resuscitation immediately following delivery. Acidosis was noted
in the mother during the operation; it was followed by acute hepatorenal failure 16 hours
after admission. That resulted in the mother's death 40 hours after admission. The infant
also died 34 hours after delivery. CONCLUSION: Delays in administering the antidote
treatment, N-acetylcysteine, after acetaminophen intoxication significantly increase the
risk of mortality in both the mother and infant. The development of acidosis carries a
poor prognosis in such patients and may necessitate liver transplantation to save the life
of the mother.
- Treatment of acetaminophen poisoning.
Can Med Assoc J. 1981 Oct 15;125(8):827-9. Review.
PMID: 7030465 [PubMed - indexed for MEDLINE]
- [Hemorrhagic pancreatitis. A rare complication of paracetamol poisoning]
Ugeskr Laeger. 1995 Feb 13;157(7):898-9. Danish. No abstract available.
PMID: 7701652 [PubMed - indexed for MEDLINE]
- Severe acetaminophen poisoning with favorable outcome after medical treatment: report of
2 cases.
Acta Clin Belg. 1993;48(6):392-6.
PMID: 8128818 [PubMed - indexed for MEDLINE]
- Acetaminophen poisoning and its treatment.
Compr Ther. 1982 Dec;8(12):16-21. No abstract available.
PMID: 7160160 [PubMed - indexed for MEDLINE]
- Acute pancreatitis associated with celecoxib.
Ann Intern Med. 2000 Apr 18;132(8):680. No abstract available.
PMID: 10766698 [PubMed - indexed for MEDLINE]
- The real risk of acetaminophen overdose.
RN. 1985 Aug;48(8):35-7. No abstract available.
PMID: 3849088 [PubMed - indexed for MEDLINE]
- Is paracetamol an NSAID?
J Assoc Physicians India. 1991 Sep;39(9):727, 729. No abstract available.
PMID: 1814924 [PubMed - indexed for MEDLINE]
- [Acetaminophen poisoning]
Union Med Can. 1978 Jul;107(7):670-3. French. No abstract available.
PMID: 664109 [PubMed - indexed for MEDLINE]
- [Benign acute pancreatitis probably due to taking ketoprofen]
Therapie. 1998 Nov-Dec;53(6):602-3. French. No abstract available.
PMID: 10070244 [PubMed - indexed for MEDLINE]
- Fulminant heptic failure in a child following paracetamol overdosing.
Ceylon Med J. 2001 Jun;46(2):72-3. No abstract available.
PMID: 11727585 [PubMed - indexed for MEDLINE]
- Paracetamol poisoning: the action line and the timing of acetylcysteine therapy.
Ir Med J. 1996 Sep-Oct;89(5):156, 158. Review. No abstract available.
PMID: 8936831 [PubMed - indexed for MEDLINE]
- Hepatotoxicity in acetaminophen poisoning.
Mayo Clin Proc. 1977 Apr;52(4):246-8.
PMID: 846223 [PubMed - indexed for MEDLINE]
- Treatment of acetaminophen poisoning.
Can Med Assoc J. 1982 Feb 1;126(3):232. No abstract available.
PMID: 7059898 [PubMed - indexed for MEDLINE]
- Acetaminophen overdose.
Am J Psychiatry. 1978 Jan;135(1):114-5. No abstract available.
PMID: 618508 [PubMed - indexed for MEDLINE]
- Distinction made between toxicoses caused by acetaminophen and nonsteroidal
anti-inflammatory drugs.
J Am Vet Med Assoc. 1992 Nov 1;201(9):1318-9. No abstract available.
PMID: 1429174 [PubMed - indexed for MEDLINE]
- The epidemiology of acetaminophen (paracetamol) poisoning in Hong Kong.
Vet Hum Toxicol. 1996 Dec;38(6):443-4.
PMID: 8948078 [PubMed - indexed for MEDLINE]
- When does acetaminophen poisoning require treatment?
Postgrad Med. 1991 Oct;90(5):272. No abstract available.
PMID: 1924013 [PubMed - indexed for MEDLINE]
- Subacute acetaminophen overdose after incremental dosing.
J Emerg Med. 1988 Jan-Feb;6(1):37-40. Review.
PMID: 3283215 [PubMed - indexed for MEDLINE]
A case of acetaminophen poisoning following the ingestion of 26 g of acetaminophen by
incremental dosing over a 25-h period is reported. At presentation, seven h after the last
ingestion, the patient experienced hematemesis, the acetaminophen level was 150
micrograms/mL, and the SGOT was normal. The patient recovered uneventfully following
N-acetylcysteine therapy. A review of the pharmacology and toxicity of acetaminophen is
discussed. The case illustrates the problems of judging hepatotoxic potential in a
multiple-dose acetaminophen ingestion and describes the successful use of N-acetylcysteine
in a patient with a "subacute" acetaminophen overdose.
- [Is chronic poisoning with acetaminophen in children a frequent occurrence in Toronto?]
Can J Clin Pharmacol. 2001 Summer;8(2):96-101.
PMID: 11493938 [PubMed - indexed for MEDLINE]
BACKGROUND: Acetaminophen is a common cause of poisoning in children. Recent American
studies suggest that acetaminophen poisonings pose serious risks in children, particularly
in the case of chronic poisoning caused by therapeutic error. OBJECTIVE: To evaluate
whether chronic acetaminophen poisoning in children is a frequent occurrence in a large,
Canadian, urban population. PATIENTS AND METHODS: Retrospective study. Charts of all
patients admitted to The Hospital for Sick Children, Toronto, Ontario from January 1, 1990
to June 31, 1996 with an acetaminophen overdose were reviewed. RESULTS: A total of 110
patients were admitted within the study period; only four of whom were preschool children
(younger than five years of age). Among the preschool children, three had an acute
overdose and one had possible chronic poisoning by therapeutic error. All preschool
children were treated with N-acetylcysteine; one developed hepatotoxicity (aspartate
aminotransferase or alanine aminotransferase greater than 1000 U/L) after presenting 24 h
after acute ingestion. Of the remaining patients, all were adolescents; 102 had acute
intentional overdose and four had staggered intentional overdoses. Fifty-three adolescents
were treated with N-acetyl cysteine. Hepatotoxicity was present in 13 of 63 adolescents
(21%). No patients required liver transplantation or died. CONCLUSIONS: Contrary to
American experience, chronic acetaminophen poisoning, including therapeutic error in
children in Toronto, is a rare occurrence--most cases of acetaminophen poisonings are
acute intentional ingestion in adolescents.
- Ibuprofen overdose presenting with severe agitation and hypothermia.
Am J Emerg Med. 1998 Sep;16(5):549-50. No abstract available.
PMID: 9725984 [PubMed - indexed for MEDLINE]
- Acetaminophen poisoning.
J Fam Pract. 1978 Nov;7(5):953-6.
PMID: 722269 [PubMed - indexed for MEDLINE]
- When acetaminophen use becomes toxic. Treating acute accidental and intentional
overdose.
Postgrad Med. 1999 Apr;105(4):81-4, 87, 90. Review.
PMID: 10223088 [PubMed - indexed for MEDLINE]
- Fatal hepatitis and renal failure during treatment with nimesulide.
J Intern Med. 2000 Jan;247(1):153-5.
PMID: 10672143 [PubMed - indexed for MEDLINE]A healthy 70-year-old woman who took
nimesulide for 5 days, presented 2 weeks later with jaundice for which no other cause was
found. Laboratory evidence of coagulopathy, hypoalbuminaemia and hypoglycaemia were
present on admission, and liver biopsy showed massive necrosis of hepatocytes and severe
inflammatory infiltrate. Despite supportive and corticosteroid treatment, her jaundice
deepened and progressive acute renal failure developed, characterized by a 'prerenal'
profile changing into irreversible acute tubular necrosis pattern, coma, occult
Gram-negative sepsis and death. Although rare, nimesulide-associated hepatotoxicity and
nephrotoxicity may occur and should be recognized as early as possible, to ensure
immediate drug withdrawal and treatment.
- Acute acetaminophen intoxication.
South Med J. 1978 Aug;71(8):906-8.
PMID: 684469 [PubMed - indexed for MEDLINE]
Acetaminophen is a readily available, widely used drug which has been thought safer
than aspirin. Overdosage which may result in fatal hepatic necrosis is commonly seen in
the United Kingdom but is rarely reported in the United States. In a two-month period,
three patients were admitted to a general hospital because of acetaminophen overdose,
suggesting that this problem may occur more commonly than expected. They were successfully
treated with N-acetylcysteine. Our experience in management of these three patients is
presented and the pertinent literature concerning diagnosis and treatment of acute
acetaminophen intoxication in briefly reviewed.
- N-acetylcysteine in the treatment of acetaminophen overdose.
N Engl J Med. 1989 May 25;320(21):1417-8. No abstract available.
PMID: 2634982 [PubMed - indexed for MEDLINE]
- Paracetamol-induced acute pancreatitis.
Br Med J. 1977 Apr 23;1(6068):1086. No abstract available.
PMID: 858062 [PubMed - indexed for MEDLINE]
- Paracetamol-associated coma, metabolic acidosis, renal and hepatic failure.
Intensive Care Med. 1988;14(4):439-40.
PMID: 3403780 [PubMed - indexed for MEDLINE]
- Acetaminophen overdose.
Ann Emerg Med. 1995 Jan;25(1):117-8. No abstract available.
PMID: 7802362 [PubMed - indexed for MEDLINE]
- Paracetamol, nonsteroidal antiinflammatory drugs and nephrotoxicity.
N Z Med J. 1991 May 8;104(911):182-3. Review. No abstract available.
PMID: 2027607 [PubMed - indexed for MEDLINE]
- Paracetamol (acetaminophen) poisoning.
Lancet. 1995 Aug 26;346(8974):547-52. Review. No abstract available.
PMID: 7658783 [PubMed - indexed for MEDLINE]
- [Treatment of paracetamol poisoning. An indication for liver transplantation?]
Tidsskr Nor Laegeforen. 1994 Apr 20;114(10):1199-203. Norwegian.
PMID: 8209319 [PubMed - indexed for MEDLINE]
Development of metabolic acidosis (pH < 7.30) or the combination of
encephalopathy grade III-IV, coagulopathy (PT > 100s) and oliguric renal failure are
associated with a poor prognosis in paracetamol-induced fulminant liver failure. It is
important to administer N-acetylcysteine as soon as possible after the overdose, but
N-acetyl-cysteine also seems to improve survival when given 36-80h following ingestion.
Liver transplantation has been performed in some patients with paracetamol-induced
fulminant liver failure, but convincing evidence that transplantation improves survival in
this group of patients is still lacking. We discuss the difficulties met in deciding if
and when to perform liver transplantation. Renal failure may develop some days after
paracetamol poisoning, even in the absence of severe liver damage, and haemofiltration and
haemodialysis may be necessary.
- Massive sulfasalazine and paracetamol ingestion causing acidosis, hyperglycemia,
coagulopathy, and methemoglobinemia.
J Toxicol Clin Toxicol. 1998;36(3):239-42.
PMID: 9656981 [PubMed - indexed for MEDLINE]