KMID : 1013220210190010031
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Jouranl of the Korean Society of Clinical Toxicology 2021 Volume.19 No. 1 p.31 ~ p.37
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Laboratory analysis of acute acetaminophen overdose patients in Emergency Medical Centers: including analysis of one toxicological laboratory data
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Kim In-Chan
Won Sin-Ae Lee A-Rum Jung Ha-Eun Lee Jeong-Sun Oh Bum-Jin
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Abstract
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Purpose: Acetaminophen (APAP) is a widely available drug responsible for a large part of drug-induced hepatotoxicity in developed countries. Although acetaminophen overdose cases in Korea are being continuously reported, there are no reports related to the level of this drug in the patient¡¯s blood or of laboratory analysis at emergency departments (ED). This study sought to analyze the acetaminophen overdose cases at a toxicological laboratory and to survey APAP analysis services offered at select EDs.
Methods: We analyzed the demographic and analytic data at a toxicological laboratory run by the National Emergency Medical Center (NMC) in 2019-2020. We surveyed the APAP laboratory service in the 38 regional emergency medical centers (EMCs) and 68 local EMCs near the toxicological laboratory.
Results: We studied 175 acute poisoning cases (112 women) with positive blood APAP results (mean age 47.0¡¾24.1 years). Suicide attempts comprised 40.0% of the cases and 30.3% APAP overdose events. In the univariate analysis, we observed that patients were significantly younger, with fewer underlying medical diseases. There were a higher number of APAP overdose events, more favorable initial mental status, more toxic quantity intake in the above treatment line group (p<0.05), In multivariate analysis, the toxic amount intake was significantly more frequent in the above treatment line group (p<0.01). Hospital APAP analysis services were available in six EMCs (3/38 regional and 3/68 local). The hospital blood APAP level reporting intervals were shorter than outside-hospital laboratory services (p<0.01, regional 7.0¡¾3.0 vs. 40.6¡¾27.5, local 5.3¡¾3.1 vs. 57.9¡¾45.1 hours). The NMC toxicological laboratory reporting interval was shorter than the other outside-hospital laboratories (p<0.01, regional 5.7¡¾ 0.6 vs. 50.2¡¾22.7 local 7.5¡¾3.0 vs. 70.5¡¾41.5 hours).
Conclusion: Over the treatment line group, toxic amount intake was significantly more frequent. Only six of 106 EMCs have their own APAP analysis service in their hospitals.
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KEYWORD
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Acetaminophen, Paracetamol, Poisoning, Analysis
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