Changing the Management of Paracetamol Poisoning

The management of paracetamol poisoning was revolutionized after use of acetylcysteine in the 1970s. The protocol used, 3 weight-related infusions, requires almost 24 hours in hospital. It is associated with adverse events in treated patients, particularly anaphylactoid reactions and vomiting. Prese...

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Published in:	Clinical therapeutics Vol. 37; no. 9; pp. 2135 - 2141
Main Author:	Bateman, D. Nicholas
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01.09.2015 Elsevier Limited
Subjects:	Acetaminophen - poisoning Acetylcysteine - administration & dosage Acetylcysteine - adverse effects Analgesics Analgesics, Non-Narcotic - poisoning Anaphylaxis - chemically induced antidotes Antidotes - administration & dosage Antidotes - adverse effects Antiemetics - therapeutic use Biomarkers - blood Chemical and Drug Induced Liver Injury - drug therapy Chemical and Drug Induced Liver Injury - etiology Clinical Protocols Clinical trials Conflicts of interest Drug overdose Free Radical Scavengers - administration & dosage Free Radical Scavengers - adverse effects HMGB1 Protein - blood Hospitals Humans Internal Medicine Liver Medical Education MicroRNAs - blood Ondansetron - therapeutic use paracetamol overdose Poisoning Risk assessment Rodents Vomiting - chemically induced United Kingdom > UK paracetamol overdose antidotes risk assessment
ISSN:	0149-2918, 1879-114X
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Abstract	The management of paracetamol poisoning was revolutionized after use of acetylcysteine in the 1970s. The protocol used, 3 weight-related infusions, requires almost 24 hours in hospital. It is associated with adverse events in treated patients, particularly anaphylactoid reactions and vomiting. Present treatment nomograms were based on a small series of untreated patients: only 5 of 22 (23%) and 6 of 25 (24%) between the 100 to 200 mg/L and 200 to 300 mg/L nomogram lines, respectively, developed liver injury (alanine transaminase >1000 IU/L). Many patients treated today are unlikely to be at actual risk for major hepatotoxicity. This article discusses the background to future prospects in this area. The history behind approaches to the use of acetylcysteine is presented briefly. The rationale for, and key findings of, a new 12-hour antidote regimen for paracetamol poisoning are detailed. Newer markers of hepatotoxicity, such as miR-122, HMGB1, and necrosis K18, which predict patients at risk more reliably and earlier than existing tests, are discussed. A 2-phase 12-hour acetylcysteine infusion protocol (100 mg/kg over 2 hours: 200 mg/kg over 10 hours) was studied in a formal factorial design against the traditional 3-phase 20.25-hour infusion protocol, with and without pretreatment with ondansetron or placebo. The 12-hour regimen was associated with very significant reductions in anaphylactoid reactions (odds ratio = 0.23; 95% CI, 0.12−0.43; P < 0.0001) and vomiting (odds ratio = 0.37; 95% CI, 0.18−0.79; P = .003) compared with the 20.25-hour infusion protocol. There were few withdrawals from the clinical trial, indicating the feasibility of conducting such studies in Europe. Novel proteomic markers are better than existing standard tests (alanine transaminase and international normalized ratio) early in the course of paracetamol poisoning. Together with these new biomarkers of hepatotoxicity, a 12-hour acetylcysteine protocol offers clinicians and patients the possibility for better targeting of therapy, fewer adverse effects, a simpler dosing regimen, and shorter hospital stay.
AbstractList	Abstract Purpose The management of paracetamol poisoning was revolutionized after use of acetylcysteine in the 1970s. The protocol used, 3 weight-related infusions, requires almost 24 hours in hospital. It is associated with adverse events in treated patients, particularly anaphylactoid reactions and vomiting. Present treatment nomograms were based on a small series of untreated patients: only 5 of 22 (23%) and 6 of 25 (24%) between the 100 to 200 mg/L and 200 to 300 mg/L nomogram lines, respectively, developed liver injury (alanine transaminase >1000 IU/L). Many patients treated today are unlikely to be at actual risk for major hepatotoxicity. This article discusses the background to future prospects in this area. Methods The history behind approaches to the use of acetylcysteine is presented briefly. The rationale for, and key findings of, a new 12-hour antidote regimen for paracetamol poisoning are detailed. Newer markers of hepatotoxicity, such as miR-122, HMGB1, and necrosis K18, which predict patients at risk more reliably and earlier than existing tests, are discussed. Findings A 2-phase 12-hour acetylcysteine infusion protocol (100 mg/kg over 2 hours: 200 mg/kg over 10 hours) was studied in a formal factorial design against the traditional 3-phase 20.25-hour infusion protocol, with and without pretreatment with ondansetron or placebo. The 12-hour regimen was associated with very significant reductions in anaphylactoid reactions (odds ratio = 0.23; 95% CI, 0.12−0.43; P < 0.0001) and vomiting (odds ratio = 0.37; 95% CI, 0.18−0.79; P = .003) compared with the 20.25-hour infusion protocol. There were few withdrawals from the clinical trial, indicating the feasibility of conducting such studies in Europe. Implications Novel proteomic markers are better than existing standard tests (alanine transaminase and international normalized ratio) early in the course of paracetamol poisoning. Together with these new biomarkers of hepatotoxicity, a 12-hour acetylcysteine protocol offers clinicians and patients the possibility for better targeting of therapy, fewer adverse effects, a simpler dosing regimen, and shorter hospital stay. The management of paracetamol poisoning was revolutionized after use of acetylcysteine in the 1970s. The protocol used, 3 weight-related infusions, requires almost 24 hours in hospital. It is associated with adverse events in treated patients, particularly anaphylactoid reactions and vomiting. Present treatment nomograms were based on a small series of untreated patients: only 5 of 22 (23%) and 6 of 25 (24%) between the 100 to 200 mg/L and 200 to 300 mg/L nomogram lines, respectively, developed liver injury (alanine transaminase >1000 IU/L). Many patients treated today are unlikely to be at actual risk for major hepatotoxicity. This article discusses the background to future prospects in this area. The history behind approaches to the use of acetylcysteine is presented briefly. The rationale for, and key findings of, a new 12-hour antidote regimen for paracetamol poisoning are detailed. Newer markers of hepatotoxicity, such as miR-122, HMGB1, and necrosis K18, which predict patients at risk more reliably and earlier than existing tests, are discussed. A 2-phase 12-hour acetylcysteine infusion protocol (100 mg/kg over 2 hours: 200 mg/kg over 10 hours) was studied in a formal factorial design against the traditional 3-phase 20.25-hour infusion protocol, with and without pretreatment with ondansetron or placebo. The 12-hour regimen was associated with very significant reductions in anaphylactoid reactions (odds ratio = 0.23; 95% CI, 0.12−0.43; P < 0.0001) and vomiting (odds ratio = 0.37; 95% CI, 0.18−0.79; P = .003) compared with the 20.25-hour infusion protocol. There were few withdrawals from the clinical trial, indicating the feasibility of conducting such studies in Europe. Novel proteomic markers are better than existing standard tests (alanine transaminase and international normalized ratio) early in the course of paracetamol poisoning. Together with these new biomarkers of hepatotoxicity, a 12-hour acetylcysteine protocol offers clinicians and patients the possibility for better targeting of therapy, fewer adverse effects, a simpler dosing regimen, and shorter hospital stay. Purpose The management of paracetamol poisoning was revolutionized after use of acetylcysteine in the 1970s. The protocol used, 3 weight-related infusions, requires almost 24 hours in hospital. It is associated with adverse events in treated patients, particularly anaphylactoid reactions and vomiting. Present treatment nomograms were based on a small series of untreated patients: only 5 of 22 (23%) and 6 of 25 (24%) between the 100 to 200 mg/L and 200 to 300 mg/L nomogram lines, respectively, developed liver injury (alanine transaminase >1000 IU/L). Many patients treated today are unlikely to be at actual risk for major hepatotoxicity. This article discusses the background to future prospects in this area. Methods The history behind approaches to the use of acetylcysteine is presented briefly. The rationale for, and key findings of, a new 12-hour antidote regimen for paracetamol poisoning are detailed. Newer markers of hepatotoxicity, such as miR-122, HMGB1, and necrosis K18, which predict patients at risk more reliably and earlier than existing tests, are discussed. Findings A 2-phase 12-hour acetylcysteine infusion protocol (100 mg/kg over 2 hours: 200 mg/kg over 10 hours) was studied in a formal factorial design against the traditional 3-phase 20.25-hour infusion protocol, with and without pretreatment with ondansetron or placebo. The 12-hour regimen was associated with very significant reductions in anaphylactoid reactions (odds ratio = 0.23; 95% CI, 0.12-0.43; P < 0.0001) and vomiting (odds ratio = 0.37; 95% CI, 0.18-0.79; P = .003) compared with the 20.25-hour infusion protocol. There were few withdrawals from the clinical trial, indicating the feasibility of conducting such studies in Europe. Implications Novel proteomic markers are better than existing standard tests (alanine transaminase and international normalized ratio) early in the course of paracetamol poisoning. Together with these new biomarkers of hepatotoxicity, a 12-hour acetylcysteine protocol offers clinicians and patients the possibility for better targeting of therapy, fewer adverse effects, a simpler dosing regimen, and shorter hospital stay. The management of paracetamol poisoning was revolutionized after use of acetylcysteine in the 1970s. The protocol used, 3 weight-related infusions, requires almost 24 hours in hospital. It is associated with adverse events in treated patients, particularly anaphylactoid reactions and vomiting. Present treatment nomograms were based on a small series of untreated patients: only 5 of 22 (23%) and 6 of 25 (24%) between the 100 to 200 mg/L and 200 to 300 mg/L nomogram lines, respectively, developed liver injury (alanine transaminase >1000 IU/L). Many patients treated today are unlikely to be at actual risk for major hepatotoxicity. This article discusses the background to future prospects in this area. The history behind approaches to the use of acetylcysteine is presented briefly. The rationale for, and key findings of, a new 12-hour antidote regimen for paracetamol poisoning are detailed. Newer markers of hepatotoxicity, such as miR-122, HMGB1, and necrosis K18, which predict patients at risk more reliably and earlier than existing tests, are discussed. A 2-phase 12-hour acetylcysteine infusion protocol (100 mg/kg over 2 hours: 200 mg/kg over 10 hours) was studied in a formal factorial design against the traditional 3-phase 20.25-hour infusion protocol, with and without pretreatment with ondansetron or placebo. The 12-hour regimen was associated with very significant reductions in anaphylactoid reactions (odds ratio = 0.23; 95% CI, 0.12-0.43; P < 0.0001) and vomiting (odds ratio = 0.37; 95% CI, 0.18-0.79; P = .003) compared with the 20.25-hour infusion protocol. There were few withdrawals from the clinical trial, indicating the feasibility of conducting such studies in Europe. Novel proteomic markers are better than existing standard tests (alanine transaminase and international normalized ratio) early in the course of paracetamol poisoning. Together with these new biomarkers of hepatotoxicity, a 12-hour acetylcysteine protocol offers clinicians and patients the possibility for better targeting of therapy, fewer adverse effects, a simpler dosing regimen, and shorter hospital stay. PURPOSEThe management of paracetamol poisoning was revolutionized after use of acetylcysteine in the 1970s. The protocol used, 3 weight-related infusions, requires almost 24 hours in hospital. It is associated with adverse events in treated patients, particularly anaphylactoid reactions and vomiting. Present treatment nomograms were based on a small series of untreated patients: only 5 of 22 (23%) and 6 of 25 (24%) between the 100 to 200 mg/L and 200 to 300 mg/L nomogram lines, respectively, developed liver injury (alanine transaminase >1000 IU/L). Many patients treated today are unlikely to be at actual risk for major hepatotoxicity. This article discusses the background to future prospects in this area.METHODSThe history behind approaches to the use of acetylcysteine is presented briefly. The rationale for, and key findings of, a new 12-hour antidote regimen for paracetamol poisoning are detailed. Newer markers of hepatotoxicity, such as miR-122, HMGB1, and necrosis K18, which predict patients at risk more reliably and earlier than existing tests, are discussed.FINDINGSA 2-phase 12-hour acetylcysteine infusion protocol (100 mg/kg over 2 hours: 200 mg/kg over 10 hours) was studied in a formal factorial design against the traditional 3-phase 20.25-hour infusion protocol, with and without pretreatment with ondansetron or placebo. The 12-hour regimen was associated with very significant reductions in anaphylactoid reactions (odds ratio = 0.23; 95% CI, 0.12-0.43; P < 0.0001) and vomiting (odds ratio = 0.37; 95% CI, 0.18-0.79; P = .003) compared with the 20.25-hour infusion protocol. There were few withdrawals from the clinical trial, indicating the feasibility of conducting such studies in Europe.IMPLICATIONSNovel proteomic markers are better than existing standard tests (alanine transaminase and international normalized ratio) early in the course of paracetamol poisoning. Together with these new biomarkers of hepatotoxicity, a 12-hour acetylcysteine protocol offers clinicians and patients the possibility for better targeting of therapy, fewer adverse effects, a simpler dosing regimen, and shorter hospital stay.
Author	Bateman, D. Nicholas
Author_xml	– sequence: 1 givenname: D. Nicholas surname: Bateman fullname: Bateman, D. Nicholas email: nbateman@staffmail.ed.ac.uk organization: Pharmacology, Toxicology and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
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Cites_doi	10.1056/NEJM198812153192401 10.1016/S0140-6736(71)91125-1 10.3109/15563650.2014.987397 10.1093/qjmed/hct062 10.3109/15563650.2010.523828 10.1046/j.0306-5251.2001.01490.x 10.3109/15563650.2013.799677 10.1007/BF00558131 10.1136/bmj.2.5512.497 10.1080/15563650802245497 10.3109/15563650.2014.952432 10.1080/15563650802665587 10.1016/S0022-3565(25)29666-5 10.1542/peds.55.6.871 10.3109/15563651003610179 10.1136/bmj.303.6809.1026 10.1111/bcp.12635 10.1136/bmj.2.6198.1097 10.3109/15563650.2013.830733 10.1111/bcp.12362 10.3109/15563650.2010.523829 10.1111/bcp.12214 10.4049/jimmunol.1100165 10.1177/096032718400300504 10.2165/00003088-198207020-00001 10.3109/15563650.2012.659252 10.1186/2050-6511-14-20 10.1586/ecp.12.15 10.1007/s00228-008-0580-9 10.1016/j.annemergmed.2004.08.040 10.1016/S0140-6736(13)62062-0 10.1002/hep.26294 10.1586/17512433.2014.880650 10.1016/S0140-6736(76)92842-7 10.1093/qjmed/hcm003 10.1136/bmj.2.5512.506 10.1136/bmj.d2218
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References	Prescott, Illingworth, Critchley (bib7) 1979; 2 Schmidt (bib29) 2013; 51 Rumack, Matthew (bib8) 1975; 55 Waring, Pettie, Dow, Bateman (bib28) 2006; 44 Sivilotti, Green, Langmann (bib36) 2010; 48 Accessed May 13, 2013 Keays, Harrison, Wendon (bib22) 1991; 303 Ferner, Langford, Anton (bib31) 2001; 52 Routledge, Vale, Bateman (bib15) 1998; 317 Dear, Antoine (bib38) 2014; 7 Smilkstein, Knapp, Kulig, Rumack (bib17) 1988; 319 Gulmez, Larrey, Pageaux (bib19) 2015 Antoine, Dear, Lewis (bib37) 2013; 58 Prescott (bib9) 1978; 36 Koppen, van Reil, de Vreis, Meulenbelt (bib26) 2014; 72 Pakravan, Waring, Bateman (bib30) 2008; 46 Mowry, Spyker, Cantilena (bib42) 2014; 52 Sandilands, Bateman (bib25) 2009; 47 Forrest, Clements, Prescott (bib11) 1982; 7 Prescott, Roscoe, Wright, Brown (bib10) 1971; 1 Beer, Pakravan, Hudson (bib13) 2007; 100 Isbister, Downes, Mcnamara (bib44) 2015; 53 Duffull, Isbister (bib33) 2013; 51 Graudins, Harper (bib43) 2015; 53 Ferner, Dear, Bateman (bib4) 2011; 342 Pakravan, Simpson, Waring (bib20) 2009; 65 Bateman, Woodhouse, Rawlins (bib24) 1984; 3 Dear, Simpson, Nicolai (bib45) 2011; 187 Bateman, Carroll, Pettie (bib16) 2014; 78 Dear, Antoine, Starkey-Lewis (bib39) 2013; 77 Davidson, Eastham (bib2) 1966; 2 Al-Hourani, Mansi, Pettie (bib35) 2013; 106 Benefit risk profile of acetylcysteine in the management of paracetamol overdose. 2012 [cited 13 May 2013]. Bateman, Dear (bib14) 2010; 48 Green, Sivilotti, Langmann (bib34) 2010; 48 Prescott, Donovan, Jarvie, Proudfoot (bib40) 1989; 37 Thanacoody, Gray, Dear (bib41) 2013; 14 Wong, Sivilotti, Dargan (bib21) 2015; 53 Bateman, Dear, Thanacoody (bib27) 2014; 383 Waring (bib18) 2012; 5 Kerr, Dawson, Whyte (bib32) 2005; 45 Mitchell, Jollow, Potter (bib3) 1973; 187 Bateman (bib23) 2014; 52 Rumack, Bateman (bib12) 2012; 50 Thomson, Prescott (bib1) 1966; 2 Prescott, Sutherland, Park (bib6) 1976; 2 Green (10.1016/j.clinthera.2015.07.012_bib34) 2010; 48 Koppen (10.1016/j.clinthera.2015.07.012_bib26) 2014; 72 Graudins (10.1016/j.clinthera.2015.07.012_bib43) 2015; 53 Thomson (10.1016/j.clinthera.2015.07.012_bib1) 1966; 2 Sandilands (10.1016/j.clinthera.2015.07.012_bib25) 2009; 47 Schmidt (10.1016/j.clinthera.2015.07.012_bib29) 2013; 51 Ferner (10.1016/j.clinthera.2015.07.012_bib4) 2011; 342 Kerr (10.1016/j.clinthera.2015.07.012_bib32) 2005; 45 Mitchell (10.1016/j.clinthera.2015.07.012_bib3) 1973; 187 Prescott (10.1016/j.clinthera.2015.07.012_bib10) 1971; 1 Beer (10.1016/j.clinthera.2015.07.012_bib13) 2007; 100 Keays (10.1016/j.clinthera.2015.07.012_bib22) 1991; 303 Bateman (10.1016/j.clinthera.2015.07.012_bib24) 1984; 3 Dear (10.1016/j.clinthera.2015.07.012_bib38) 2014; 7 Bateman (10.1016/j.clinthera.2015.07.012_bib14) 2010; 48 Waring (10.1016/j.clinthera.2015.07.012_bib28) 2006; 44 Prescott (10.1016/j.clinthera.2015.07.012_bib6) 1976; 2 Wong (10.1016/j.clinthera.2015.07.012_bib21) 2015; 53 Dear (10.1016/j.clinthera.2015.07.012_bib39) 2013; 77 Duffull (10.1016/j.clinthera.2015.07.012_bib33) 2013; 51 Al-Hourani (10.1016/j.clinthera.2015.07.012_bib35) 2013; 106 Bateman (10.1016/j.clinthera.2015.07.012_bib23) 2014; 52 Pakravan (10.1016/j.clinthera.2015.07.012_bib30) 2008; 46 Smilkstein (10.1016/j.clinthera.2015.07.012_bib17) 1988; 319 Forrest (10.1016/j.clinthera.2015.07.012_bib11) 1982; 7 Davidson (10.1016/j.clinthera.2015.07.012_bib2) 1966; 2 Gulmez (10.1016/j.clinthera.2015.07.012_bib19) 2015 Thanacoody (10.1016/j.clinthera.2015.07.012_bib41) 2013; 14 Pakravan (10.1016/j.clinthera.2015.07.012_bib20) 2009; 65 Sivilotti (10.1016/j.clinthera.2015.07.012_bib36) 2010; 48 Isbister (10.1016/j.clinthera.2015.07.012_bib44) 2015; 53 Rumack (10.1016/j.clinthera.2015.07.012_bib12) 2012; 50 Prescott (10.1016/j.clinthera.2015.07.012_bib9) 1978; 36 Mowry (10.1016/j.clinthera.2015.07.012_bib42) 2014; 52 Prescott (10.1016/j.clinthera.2015.07.012_bib7) 1979; 2 Bateman (10.1016/j.clinthera.2015.07.012_bib16) 2014; 78 Dear (10.1016/j.clinthera.2015.07.012_bib45) 2011; 187 Routledge (10.1016/j.clinthera.2015.07.012_bib15) 1998; 317 10.1016/j.clinthera.2015.07.012_bib5 Ferner (10.1016/j.clinthera.2015.07.012_bib31) 2001; 52 Rumack (10.1016/j.clinthera.2015.07.012_bib8) 1975; 55 Prescott (10.1016/j.clinthera.2015.07.012_bib40) 1989; 37 Antoine (10.1016/j.clinthera.2015.07.012_bib37) 2013; 58 Waring (10.1016/j.clinthera.2015.07.012_bib18) 2012; 5 Bateman (10.1016/j.clinthera.2015.07.012_bib27) 2014; 383
References_xml	– volume: 2 start-page: 506 year: 1966 end-page: 507 ident: bib1 article-title: Liver damage and impaired glucose tolerance after paracetamol overdosage publication-title: Br Med J – volume: 52 start-page: 573 year: 2001 end-page: 577 ident: bib31 article-title: Random and systematic medication errors in routine clinical practice: a multicentre study of infusions, using acetylcysteine as an example publication-title: Br J Clin Pharmacol – volume: 53 start-page: 353 year: 2015 ident: bib21 article-title: External validation of the paracetamolaminotransferase multiplication product to predict hepatotoxicity from paracetamol overdose publication-title: Clin Toxicol – volume: 7 start-page: 181 year: 2014 end-page: 189 ident: bib38 article-title: Stratification of paracetamol overdose patients using new toxicity biomarkers: current candidates and future challenges publication-title: Expert Rev Clin Pharmacol – reference: . Accessed May 13, 2013 – volume: 3 start-page: 393 year: 1984 end-page: 398 ident: bib24 article-title: Adverse reactions to N-acetylcysteine publication-title: Hum Toxicol – volume: 46 start-page: 697 year: 2008 end-page: 702 ident: bib30 article-title: Risk factors and mechanisms of anaphylactoid reactions to acetylcysteine in acetaminophen overdose publication-title: Clin Toxicol – volume: 58 start-page: 777 year: 2013 end-page: 787 ident: bib37 article-title: Mechanistic biomarkers provide early and sensitive detection of acetaminophen-induced acute liver injury at first presentation to hospital publication-title: Hepatology – volume: 342 start-page: d2218 year: 2011 ident: bib4 article-title: Management of paracetamol poisoning publication-title: BMJ – volume: 319 start-page: 1557 year: 1988 end-page: 1562 ident: bib17 article-title: Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose. Analysis of the national multicenter study (1976 to 1985) publication-title: N Engl J Med – volume: 100 start-page: 93 year: 2007 end-page: 96 ident: bib13 article-title: Liver unit admission following paracetamol overdose with concentrations below current UK treatment thresholds publication-title: QJM – reference: Benefit risk profile of acetylcysteine in the management of paracetamol overdose. 2012 [cited 13 May 2013]. – volume: 53 start-page: 249 year: 2015 ident: bib43 article-title: Comparison of adverse drug reaction rates using a two-bag to a standard three-bag intravenous acetylcysteine regimen for paracetamol poisoning publication-title: Clin Toxicol – volume: 5 start-page: 311 year: 2012 end-page: 318 ident: bib18 article-title: Criteria for acetylcysteine treatment and clinical outcomes after paracetamol poisoning publication-title: Expert Rev Clin Pharmacol – volume: 44 start-page: 441 year: 2006 end-page: 442 ident: bib28 article-title: Paracetamol appears to protect against N-acetylcysteine-induced anaphylactoid reactions publication-title: Clin Toxicol – volume: 47 start-page: 81 year: 2009 end-page: 88 ident: bib25 article-title: Adverse reactions associated with acetylcysteine publication-title: Clin Toxicol – volume: 53 start-page: 249 year: 2015 end-page: 250 ident: bib44 article-title: A novel infusion protocol for the administration of acetylcysteine publication-title: Clin Toxicol – volume: 36 start-page: 204 year: 1978 end-page: 212 ident: bib9 article-title: The chief scientist reports . . . prevention of hepatic necrosis following paracetamol overdosage publication-title: Health Bull – volume: 2 start-page: 1097 year: 1979 end-page: 1100 ident: bib7 article-title: Intravenous N-acetylcystine: the treatment of choice for paracetamol poisoning publication-title: Br Med J – volume: 55 start-page: 871 year: 1975 end-page: 876 ident: bib8 article-title: Actaminophen poiosning and toxicity publication-title: Paediatrics – volume: 383 start-page: 697 year: 2014 end-page: 704 ident: bib27 article-title: Reduction of adverse effects from intravenous acetylcysteine treatment for paracetamol poisoning: a randomised controlled trial publication-title: Lancet – volume: 14 start-page: 20 year: 2013 ident: bib41 article-title: Scottish and Newcastle antiemetic pre-treatment for paracetamol poisoning study (SNAP) publication-title: BMC Pharmacol Toxicol – volume: 1 start-page: 519 year: 1971 end-page: 522 ident: bib10 article-title: Plasma-paracetamol half-life and hepatic necrosis in patients with paracetamol overdosage publication-title: Lancet – volume: 51 start-page: 467 year: 2013 end-page: 472 ident: bib29 article-title: Identification of patients at risk of anaphylactoid reactions to N-acetylcysteine in the treatment of paracetamol overdose publication-title: Clin Toxicol – volume: 51 start-page: 772 year: 2013 end-page: 776 ident: bib33 article-title: Predicting the requirement for N-acetylcysteine in paracetamol poisoning from reported dose publication-title: Clin Toxicol – volume: 187 start-page: 3347 year: 2011 end-page: 3352 ident: bib45 article-title: Cyclophilin A is a damage-associated molecular pattern molecule that mediates acetaminophen-induced liver injury publication-title: J Immunol – volume: 106 start-page: 541 year: 2013 end-page: 546 ident: bib35 article-title: The predictive value of hospital admission serum alanine transaminase activity in patients treated for paracetamol overdose publication-title: QJM – volume: 78 start-page: 610 year: 2014 end-page: 618 ident: bib16 article-title: Effect of the UK’s revised paracetamol poisoning management guidelines on admissions, adverse reactions and costs of treatment publication-title: Br J Clin Pharmacol – volume: 52 start-page: 821 year: 2014 end-page: 823 ident: bib23 article-title: Pack size and paracetamol overdose: 16 years later publication-title: Clin Toxicol – volume: 37 start-page: 501 year: 1989 end-page: 506 ident: bib40 article-title: The disposition and kinetics of intravenous N-acetylcysteine in patients with paracetamol overdosage publication-title: Eur J Clin Pharmacol – volume: 303 start-page: 1026 year: 1991 end-page: 1029 ident: bib22 article-title: Intravenous acetylcysteine in paracetamol induced fulminant hepatic failure: a prospective controlled trial publication-title: BMJ – volume: 65 start-page: 163 year: 2009 end-page: 168 ident: bib20 article-title: Renal injury at first presentation as a predictor for poor outcome in severe paracetamol poisoning referred to a liver transplant unit publication-title: Eur J Clin Pharmacol – volume: 2 start-page: 497 year: 1966 end-page: 499 ident: bib2 article-title: Acute liver necrosis following overdose of paracetamol publication-title: Br Med J – volume: 187 start-page: 211 year: 1973 end-page: 217 ident: bib3 article-title: Acetaminophen-induced hepatic necrosis. IV. Protective role of glutathione publication-title: J Pharmacol Exp Ther – volume: 45 start-page: 402 year: 2005 end-page: 408 ident: bib32 article-title: The Australasian Clinical Toxicology Investigators Collaboration randomized trial of different loading infusion rates of N-acetylcysteine publication-title: Ann Emerg Med – volume: 48 start-page: 793 year: 2010 end-page: 799 ident: bib36 article-title: Multiplying the serum aminotransferase by the acetaminophen concentration to predict toxicity following overdose publication-title: Clin Toxicol – volume: 48 start-page: 97 year: 2010 end-page: 103 ident: bib14 article-title: Medicine, poison, and mystic potion: a personal perspective on paracetamol Louis Roche lecture, Stockholm, 2009 publication-title: Clin Toxicol – volume: 77 start-page: 904 year: 2013 end-page: 905 ident: bib39 article-title: Early detection of paracetamol toxicity using circulating liver microRNA and markers of cell necrosis publication-title: B J Clin Pharm – volume: 317 start-page: 1609 year: 1998 end-page: 1610 ident: bib15 article-title: Paracetamol (acetaminophen) poisoning. No need to change current guidelines to accident departments publication-title: BMJ – year: 2015 ident: bib19 article-title: Liver transplant associated with paracetamol overdose: results from the seven-country SALT study publication-title: Br J Clin Pharmacol – volume: 48 start-page: 787 year: 2010 end-page: 792 ident: bib34 article-title: When do the aminotransferases rise after acute acetaminophen overdose? publication-title: Clin Toxicol – volume: 52 start-page: 1032 year: 2014 end-page: 1283 ident: bib42 article-title: 2013 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 31st Annual Report publication-title: Clin Toxicol – volume: 50 start-page: 91 year: 2012 end-page: 98 ident: bib12 article-title: Acetaminophen and acetylcysteine dose and duration: past, present and future publication-title: Clin Toxicol – volume: 72 start-page: 251 year: 2014 end-page: 257 ident: bib26 article-title: Recommendations for the paracetamol treatment nomogram and side effects of N-acetylcysteine publication-title: Neth J Med – volume: 7 start-page: 93 year: 1982 end-page: 107 ident: bib11 article-title: Clinical pharmacokinetics of paracetamol publication-title: Clin Pharmacokinet – volume: 2 start-page: 109 year: 1976 end-page: 113 ident: bib6 article-title: Cysteamine, methionine, and penicillamine in the treatment of paracetamol poisoning publication-title: Lancet – volume: 319 start-page: 1557 year: 1988 ident: 10.1016/j.clinthera.2015.07.012_bib17 article-title: Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose. Analysis of the national multicenter study (1976 to 1985) publication-title: N Engl J Med doi: 10.1056/NEJM198812153192401 – volume: 1 start-page: 519 issue: 7698 year: 1971 ident: 10.1016/j.clinthera.2015.07.012_bib10 article-title: Plasma-paracetamol half-life and hepatic necrosis in patients with paracetamol overdosage publication-title: Lancet doi: 10.1016/S0140-6736(71)91125-1 – volume: 52 start-page: 1032 year: 2014 ident: 10.1016/j.clinthera.2015.07.012_bib42 article-title: 2013 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 31st Annual Report publication-title: Clin Toxicol doi: 10.3109/15563650.2014.987397 – volume: 106 start-page: 541 year: 2013 ident: 10.1016/j.clinthera.2015.07.012_bib35 article-title: The predictive value of hospital admission serum alanine transaminase activity in patients treated for paracetamol overdose publication-title: QJM doi: 10.1093/qjmed/hct062 – volume: 48 start-page: 787 year: 2010 ident: 10.1016/j.clinthera.2015.07.012_bib34 article-title: When do the aminotransferases rise after acute acetaminophen overdose? publication-title: Clin Toxicol doi: 10.3109/15563650.2010.523828 – volume: 44 start-page: 441 year: 2006 ident: 10.1016/j.clinthera.2015.07.012_bib28 article-title: Paracetamol appears to protect against N-acetylcysteine-induced anaphylactoid reactions publication-title: Clin Toxicol – volume: 52 start-page: 573 year: 2001 ident: 10.1016/j.clinthera.2015.07.012_bib31 article-title: Random and systematic medication errors in routine clinical practice: a multicentre study of infusions, using acetylcysteine as an example publication-title: Br J Clin Pharmacol doi: 10.1046/j.0306-5251.2001.01490.x – volume: 51 start-page: 467 year: 2013 ident: 10.1016/j.clinthera.2015.07.012_bib29 article-title: Identification of patients at risk of anaphylactoid reactions to N-acetylcysteine in the treatment of paracetamol overdose publication-title: Clin Toxicol doi: 10.3109/15563650.2013.799677 – volume: 37 start-page: 501 year: 1989 ident: 10.1016/j.clinthera.2015.07.012_bib40 article-title: The disposition and kinetics of intravenous N-acetylcysteine in patients with paracetamol overdosage publication-title: Eur J Clin Pharmacol doi: 10.1007/BF00558131 – volume: 2 start-page: 497 issue: 5512 year: 1966 ident: 10.1016/j.clinthera.2015.07.012_bib2 article-title: Acute liver necrosis following overdose of paracetamol publication-title: Br Med J doi: 10.1136/bmj.2.5512.497 – volume: 46 start-page: 697 year: 2008 ident: 10.1016/j.clinthera.2015.07.012_bib30 article-title: Risk factors and mechanisms of anaphylactoid reactions to acetylcysteine in acetaminophen overdose publication-title: Clin Toxicol doi: 10.1080/15563650802245497 – volume: 52 start-page: 821 year: 2014 ident: 10.1016/j.clinthera.2015.07.012_bib23 article-title: Pack size and paracetamol overdose: 16 years later publication-title: Clin Toxicol doi: 10.3109/15563650.2014.952432 – volume: 47 start-page: 81 year: 2009 ident: 10.1016/j.clinthera.2015.07.012_bib25 article-title: Adverse reactions associated with acetylcysteine publication-title: Clin Toxicol doi: 10.1080/15563650802665587 – volume: 187 start-page: 211 issue: 1 year: 1973 ident: 10.1016/j.clinthera.2015.07.012_bib3 article-title: Acetaminophen-induced hepatic necrosis. IV. Protective role of glutathione publication-title: J Pharmacol Exp Ther doi: 10.1016/S0022-3565(25)29666-5 – volume: 55 start-page: 871 year: 1975 ident: 10.1016/j.clinthera.2015.07.012_bib8 article-title: Actaminophen poiosning and toxicity publication-title: Paediatrics doi: 10.1542/peds.55.6.871 – volume: 48 start-page: 97 year: 2010 ident: 10.1016/j.clinthera.2015.07.012_bib14 article-title: Medicine, poison, and mystic potion: a personal perspective on paracetamol Louis Roche lecture, Stockholm, 2009 publication-title: Clin Toxicol doi: 10.3109/15563651003610179 – volume: 303 start-page: 1026 issue: 6809 year: 1991 ident: 10.1016/j.clinthera.2015.07.012_bib22 article-title: Intravenous acetylcysteine in paracetamol induced fulminant hepatic failure: a prospective controlled trial publication-title: BMJ doi: 10.1136/bmj.303.6809.1026 – year: 2015 ident: 10.1016/j.clinthera.2015.07.012_bib19 article-title: Liver transplant associated with paracetamol overdose: results from the seven-country SALT study publication-title: Br J Clin Pharmacol doi: 10.1111/bcp.12635 – volume: 2 start-page: 1097 issue: 6198 year: 1979 ident: 10.1016/j.clinthera.2015.07.012_bib7 article-title: Intravenous N-acetylcystine: the treatment of choice for paracetamol poisoning publication-title: Br Med J doi: 10.1136/bmj.2.6198.1097 – volume: 51 start-page: 772 year: 2013 ident: 10.1016/j.clinthera.2015.07.012_bib33 article-title: Predicting the requirement for N-acetylcysteine in paracetamol poisoning from reported dose publication-title: Clin Toxicol doi: 10.3109/15563650.2013.830733 – volume: 78 start-page: 610 year: 2014 ident: 10.1016/j.clinthera.2015.07.012_bib16 article-title: Effect of the UK’s revised paracetamol poisoning management guidelines on admissions, adverse reactions and costs of treatment publication-title: Br J Clin Pharmacol doi: 10.1111/bcp.12362 – volume: 72 start-page: 251 year: 2014 ident: 10.1016/j.clinthera.2015.07.012_bib26 article-title: Recommendations for the paracetamol treatment nomogram and side effects of N-acetylcysteine publication-title: Neth J Med – ident: 10.1016/j.clinthera.2015.07.012_bib5 – volume: 48 start-page: 793 year: 2010 ident: 10.1016/j.clinthera.2015.07.012_bib36 article-title: Multiplying the serum aminotransferase by the acetaminophen concentration to predict toxicity following overdose publication-title: Clin Toxicol doi: 10.3109/15563650.2010.523829 – volume: 77 start-page: 904 year: 2013 ident: 10.1016/j.clinthera.2015.07.012_bib39 article-title: Early detection of paracetamol toxicity using circulating liver microRNA and markers of cell necrosis publication-title: B J Clin Pharm doi: 10.1111/bcp.12214 – volume: 53 start-page: 249 year: 2015 ident: 10.1016/j.clinthera.2015.07.012_bib44 article-title: A novel infusion protocol for the administration of acetylcysteine publication-title: Clin Toxicol – volume: 187 start-page: 3347 year: 2011 ident: 10.1016/j.clinthera.2015.07.012_bib45 article-title: Cyclophilin A is a damage-associated molecular pattern molecule that mediates acetaminophen-induced liver injury publication-title: J Immunol doi: 10.4049/jimmunol.1100165 – volume: 3 start-page: 393 year: 1984 ident: 10.1016/j.clinthera.2015.07.012_bib24 article-title: Adverse reactions to N-acetylcysteine publication-title: Hum Toxicol doi: 10.1177/096032718400300504 – volume: 7 start-page: 93 year: 1982 ident: 10.1016/j.clinthera.2015.07.012_bib11 article-title: Clinical pharmacokinetics of paracetamol publication-title: Clin Pharmacokinet doi: 10.2165/00003088-198207020-00001 – volume: 50 start-page: 91 year: 2012 ident: 10.1016/j.clinthera.2015.07.012_bib12 article-title: Acetaminophen and acetylcysteine dose and duration: past, present and future publication-title: Clin Toxicol doi: 10.3109/15563650.2012.659252 – volume: 36 start-page: 204 year: 1978 ident: 10.1016/j.clinthera.2015.07.012_bib9 article-title: The chief scientist reports . . . prevention of hepatic necrosis following paracetamol overdosage publication-title: Health Bull – volume: 14 start-page: 20 year: 2013 ident: 10.1016/j.clinthera.2015.07.012_bib41 article-title: Scottish and Newcastle antiemetic pre-treatment for paracetamol poisoning study (SNAP) publication-title: BMC Pharmacol Toxicol doi: 10.1186/2050-6511-14-20 – volume: 53 start-page: 353 year: 2015 ident: 10.1016/j.clinthera.2015.07.012_bib21 article-title: External validation of the paracetamolaminotransferase multiplication product to predict hepatotoxicity from paracetamol overdose publication-title: Clin Toxicol – volume: 5 start-page: 311 year: 2012 ident: 10.1016/j.clinthera.2015.07.012_bib18 article-title: Criteria for acetylcysteine treatment and clinical outcomes after paracetamol poisoning publication-title: Expert Rev Clin Pharmacol doi: 10.1586/ecp.12.15 – volume: 65 start-page: 163 year: 2009 ident: 10.1016/j.clinthera.2015.07.012_bib20 article-title: Renal injury at first presentation as a predictor for poor outcome in severe paracetamol poisoning referred to a liver transplant unit publication-title: Eur J Clin Pharmacol doi: 10.1007/s00228-008-0580-9 – volume: 45 start-page: 402 year: 2005 ident: 10.1016/j.clinthera.2015.07.012_bib32 article-title: The Australasian Clinical Toxicology Investigators Collaboration randomized trial of different loading infusion rates of N-acetylcysteine publication-title: Ann Emerg Med doi: 10.1016/j.annemergmed.2004.08.040 – volume: 383 start-page: 697 issue: 9918 year: 2014 ident: 10.1016/j.clinthera.2015.07.012_bib27 article-title: Reduction of adverse effects from intravenous acetylcysteine treatment for paracetamol poisoning: a randomised controlled trial publication-title: Lancet doi: 10.1016/S0140-6736(13)62062-0 – volume: 58 start-page: 777 year: 2013 ident: 10.1016/j.clinthera.2015.07.012_bib37 article-title: Mechanistic biomarkers provide early and sensitive detection of acetaminophen-induced acute liver injury at first presentation to hospital publication-title: Hepatology doi: 10.1002/hep.26294 – volume: 53 start-page: 249 year: 2015 ident: 10.1016/j.clinthera.2015.07.012_bib43 article-title: Comparison of adverse drug reaction rates using a two-bag to a standard three-bag intravenous acetylcysteine regimen for paracetamol poisoning publication-title: Clin Toxicol – volume: 317 start-page: 1609 issue: 7173 year: 1998 ident: 10.1016/j.clinthera.2015.07.012_bib15 article-title: Paracetamol (acetaminophen) poisoning. No need to change current guidelines to accident departments publication-title: BMJ – volume: 7 start-page: 181 year: 2014 ident: 10.1016/j.clinthera.2015.07.012_bib38 article-title: Stratification of paracetamol overdose patients using new toxicity biomarkers: current candidates and future challenges publication-title: Expert Rev Clin Pharmacol doi: 10.1586/17512433.2014.880650 – volume: 2 start-page: 109 issue: 7977 year: 1976 ident: 10.1016/j.clinthera.2015.07.012_bib6 article-title: Cysteamine, methionine, and penicillamine in the treatment of paracetamol poisoning publication-title: Lancet doi: 10.1016/S0140-6736(76)92842-7 – volume: 100 start-page: 93 year: 2007 ident: 10.1016/j.clinthera.2015.07.012_bib13 article-title: Liver unit admission following paracetamol overdose with concentrations below current UK treatment thresholds publication-title: QJM doi: 10.1093/qjmed/hcm003 – volume: 2 start-page: 506 issue: 5512 year: 1966 ident: 10.1016/j.clinthera.2015.07.012_bib1 article-title: Liver damage and impaired glucose tolerance after paracetamol overdosage publication-title: Br Med J doi: 10.1136/bmj.2.5512.506 – volume: 342 start-page: d2218 year: 2011 ident: 10.1016/j.clinthera.2015.07.012_bib4 article-title: Management of paracetamol poisoning publication-title: BMJ doi: 10.1136/bmj.d2218
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Snippet	The management of paracetamol poisoning was revolutionized after use of acetylcysteine in the 1970s. The protocol used, 3 weight-related infusions, requires... Abstract Purpose The management of paracetamol poisoning was revolutionized after use of acetylcysteine in the 1970s. The protocol used, 3 weight-related... Purpose The management of paracetamol poisoning was revolutionized after use of acetylcysteine in the 1970s. The protocol used, 3 weight-related infusions,... PURPOSEThe management of paracetamol poisoning was revolutionized after use of acetylcysteine in the 1970s. The protocol used, 3 weight-related infusions,...
SourceID	proquest pubmed crossref elsevier
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StartPage	2135
SubjectTerms	Acetaminophen - poisoning Acetylcysteine - administration & dosage Acetylcysteine - adverse effects Analgesics Analgesics, Non-Narcotic - poisoning Anaphylaxis - chemically induced antidotes Antidotes - administration & dosage Antidotes - adverse effects Antiemetics - therapeutic use Biomarkers - blood Chemical and Drug Induced Liver Injury - drug therapy Chemical and Drug Induced Liver Injury - etiology Clinical Protocols Clinical trials Conflicts of interest Drug overdose Free Radical Scavengers - administration & dosage Free Radical Scavengers - adverse effects HMGB1 Protein - blood Hospitals Humans Internal Medicine Liver Medical Education MicroRNAs - blood Ondansetron - therapeutic use paracetamol overdose Poisoning Risk assessment Rodents Vomiting - chemically induced
Title	Changing the Management of Paracetamol Poisoning
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Volume	37
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