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KMID : 1013220230210020128
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Jouranl of the Korean Society of Clinical Toxicology
2023 Volume.21 No. 2 p.128 ~ p.134
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Predicting serum acetaminophen concentrations in acute poisoning for safe termination of N-acetylcysteine in a resource-limited environment
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Kim Da-Hae
Cha Kyung-Man
So Byung-Hak
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Abstract
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Purpose: The Prescott nomogram has been utilized to forecast hepatotoxicity from acute acetaminophenpoisoning. In developing countries, emergency medical centers lack the resources to report acetamino phen concentrations; thus, the commencement and cessation of treatment are based on the reporteddose. This study investigated risk factors that can predict acetaminophen detection after 15 hours forsafe treatment termination.
Methods: Data were collected from an urban emergency medical center from 2010 to 2020. The studyincluded patients ≥14 years of age with acute acetaminophen poisoning within 15 hours. The correlationbetween risk factors and detection of acetaminophen 15 hours after ingestion was evaluated using logis tic regression, and the area under the curve (AUC) was calculated.
Results: In total, 181 patients were included in the primary analysis; the median dose was 150.9 mg/kgand 35 patients (19.3%) had acetaminophen detected 15 hours after ingestion. The dose per weight andthe time to visit were significant predictors for acetaminophen detection after 15 hours (odds ratio, 1.020and 1.030, respectively). The AUCs were 0.628 for a 135 mg/kg cut-off value and 0.658 for a cut-off 450minutes, and that of the combined model was 0.714 (sensitivity: 45.7%, specificity: 91.8%).
Conclusion: Where acetaminophen concentrations are not reported during treatment following the UKguidelines, it is safe to start N-acetylcysteine immediately for patients who are ≥14 years old, visit within15 hours after acute poisoning, and report having ingested ≥135 mg/kg. Additional N-acetylcysteine dos es should be considered for patients visiting after 8 hours.
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KEYWORD
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Acetaminophen, Overdose, Acetylcysteine, Antidotes
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