Citation

Puiguriguer Ferrando J, Barceló Martín B, Castanyer Puig T, Nogué Xarau S. Emergencias 2010; 22(5): 365-368.

Copyright

(Copyright © 2010, SEMES - Sociedad Española de Medicina de Urgencias y Emergencias)

DOI

unavailable

PMID

unavailable

Abstract

The Rumack-Matthew nomogram is used to guide treatment with N-acetylcysteine (NAC) as an antidote for paracetamol intoxication, but this approach has limitations. The elimination half-life of paracetamol increases to over 4 hours in the presence of hepatic toxicity. The aim of this study is to describe the characteristics of a series of cases of paracetamol toxicity in which a nomogram could not be used; the patient's risk was assessed by means of the elimination half-life. Patients with paracetamol intoxication from a single or cumulative overdose who came to Hospital de Son Dureta de Palma de Mallorca and Hospital Clínic de Barcelona over a 5-year period (July 2005-July 2010) were included if the findings of at least 2 immunoassays for paracetamol concentration were available. Half-life was estimated by means of the ratio between 2 consecutive concentrations determined 2 hours apart. Of 11 patients with paracetamol intoxication for whom a Rumack-Matthew nomogram was not used, 3 had liver toxicity. Two of them were accidental intoxications caused by ingesting several doses of the drug. The third was an attempted suicide. In all cases, the elimination half-life exceeded 4 hours. We suggest that in cases of paracetamol intoxication the Rumack- Matthew nomogram be complemented by calculation of the elimination half-life, which will provide an indication of possible liver toxicity in these patients. This approach should be chosen at least when there are doubts about when paracetamol ingestion occurred or if intoxication is the result of several doses.

Language: en

Keywords

Paracetamol; Elimination half-life; Toxicity, liver