When the laboratory parameters were evaluated, the liver enzymes’ elevation was found in 1 patient and INR elevation was found in another patient. Mean serum acetaminophen level was found as 14.3☒3 µg/mL (min-max 0.2-107). (p= 0.008) ( Table-I).Īcetaminophen concentrations were measured from the 22 patients (37%) who ingested more than 150 mg/kg. However, there was significantly difference between ingested only acetaminophen and additional drug groups. There were no significant differences between groups (age, gender, weight, admission mean time) in terms of ingested acetaminophen dose. The mean ingested acetaminophen dose was found as 142.1☘0 mg/kg (min-max 24-300). Twenty nine of them (49%) ingested only acetaminophen but others (30, 51%) ingested more than one drug. When the admission hours were analyzed 25 of them admitted to hospital between 18:00-24:00, 17 of them between 12:00-18:00 hours, 9 of them between 00:00-06:00 hours and 8 of them between 06:00-12:00 o’clock. The mean time from ingestion of the drug to admission was found as 4.3±4.7 h (min-max 0.5-20) 50 (85%) of patients came in 8 h and all of them came to hospital in 24 h. Correlations between quantitative data were analyzed by Spearman’s correlation test. The significance between groups were evaluated with χ 2-test for qualitative data and Mann-Whitney U test for quantitative data. Descriptive statistics were given as mean, standard deviation, minimum, maximum. SPSS Statistics 20 was used for data analysis. Blood samples for acetaminophen levels were measured in laboratory of Bakırköy Mental Health and Neurology Training and Research Hospital by a multipoint homogeneous immunoassay on the Advia 1800 (Siemens, Japan). Whole blood count was measured on the Cobas 6000 CE (Roche, Germany) and XN-10 (Sysmex, Japan) was used to measure ALT, AST, urea and creatinine. Laboratory data included serum acetaminophen level, whole blood count, aspartate Aminotransferase (AST) level, alanine aminotransferase (ALT) level, serum urea level, creatinine level, Prothrombin (PT) time, activated Partial Thromboplastin Time (aPTT) and international normalized ratio (INR). 4 Decontamination (lavage and activated charcoal) and Intravenous (IV) NAC therapy was administered to patients who were exposed to toxic dose. 2 Rumack-Matthew nomogram for acute acetaminophen intake was used to evaluate the risk of acute intoxication and to determine the decision of using antidote (NAC). Age, gender, weight, amount of the ingested acetaminophen, co-ingested substances, time elapsed from ingestion, method of gastrointestinal decontamination, and antidote usage were recorded.Īmount of ingested acetaminophen was reported as milligrams per kilogram and toxic dose for acetaminophen intake was defined as greater than 150 mg/kg. The exclusion criteria were refusal of treatment or informed consent. A total of 59 patients who came to Pediatric Emergency Unit with overdose acetaminophen ingestion were included in this study. The study protocol was approved by the local ethics committee and informed consent was obtained for all children from their parents. This prospective study was conducted in Kanuni Sultan Suleyman Training and Research Hospital between August 2016 and August 2017. The aim of this study was to evaluate demographic and clinical features associated with acetaminophen overdose as well as to identify the treatment applied in our Pediatric Emergency Unit. 2 Management of acetaminophen overdose includes gastric lavage, using of activated charcoal and N-Acetylcysteine (NAC) as an antidote. As a result, this toxic metabolite accumulates and causes hepatocellular injury. ![]() If it is used overdose, glutathione stores are depleted and the clearance of NAPQI is reduced. When acetaminophen is used at the recommended doses, NAPQI is eliminated by conjugation with glutathione. However, approximately 5-10% of the drug is metabolized by Cytochrome P450 (CYP450) to a toxic metabolite, N-acetyl-p-benzoquinoneimine (NAPQI). ![]() ![]() 1Īcetaminophen is metabolized by glucuronidation and sulfation in liver. Repeated supra-therapeutic dosing and intentional or unintentional overdose usage may result in hepatic failure. Although its’ safety was well established, it is one of the common cause of drug poisoning. Acetaminophen is commonly used in children as an analgesic and antipyretic.
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