[Paracetamol poisoning at a department of hepatology].
In this retrospective study we evaluated the frequency of complications in 108 patients with acetaminophen poisoning admitted to the Department of Hepatology, Rigshospitalet, Copenhagen from 1.10.1990-30.9.1993. Twenty-five patients (23%) developed hepatic encephalopathy grade II-IV, with a survival rate of 44%. In patients who developed grade IV encephalopathy the median time from intoxication to INR > 3.7 was 60 hours. At a median of only five hours later grade II encephalopathy was present, and grade IV at a median of a further 20 hours later. Ninety-three patients were re-evaluated according to the nomogram indicated by Prescott (6). If the initial position was in the "very severe" area the risk of developing encephalopathy was 34% (20-51%), if not the risk was 6% (1-16%). Serum creatinine above 200 microM at admission indicated a risk of hepatic encephalopathy of 64% (35-87%). INR > 1.54 was associated with a 35% risk of hepatic encephalopathy. Patients in the "very severe" area should be referred to a unit where liver transplantation is possible, even if other factors known to indicate poor prognosis are not present.
Clemmesen
J O
JO
Hepatologisk afsnit, medicinsk afdeling A, Rigshospitalet, København.
Larsen
F S
FS
Ott
P
P
Hansen
B A
BA
D000082:Acetaminophen / Q000506:poisoning*; D000293:Adolescent; D000328:Adult; D000368:Aged; D056486:Chemical and Drug Induced Liver Injury / Q000401:mortality / Q000601:surgery; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006501:Hepatic Encephalopathy / Q000139:chemically induced* / Q000401:mortality; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011041:Poisoning / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies
D000082:Acetaminophen