Experiences of a poison center network with renal insufficiency in acetaminophen overdose: an analysis of 17 cases.
OBJECTIVE
Renal insufficiency is less common than liver failure in acetaminophen overdose but renal tubular damage occurs even in the absence of hepatotoxicity. Data published on this topic are rare consisting mostly of case reports or reports in a small number of patients. Presently, a larger number of patients with renal insufficiency associated with acetaminophen overdose should be analyzed using a multicenter approach.


METHODS
Retrospective analysis of patients with acetaminophen-related nephrotoxicity reported to a poison center network from 1995 to 2003. Renal insufficiency was defined as elevated serum creatinine of more than double of the normal range (>2.4 mg/dL [212 micromol/L]). Patients were classified into 4 groups (A: creatinine 2.4-5.0 mg/dL, B: creatinine>5.0 mg/dL requiring no dialysis, C: creatinine>5.0 mg/dL requiring dialysis, D: creatinine>5.0 mg/dL with fatal outcome).


RESULTS
Seventeen patients were included (8 female, 9 male, average age 31.7 +/- 21.1 yrs) with 6 patients in group A (B: 7, C: 2, D: 2). In 5 patients renal insufficiency occurred without elevation of liver enzymes. Regarding possible risk factors 5 patients concomitantly ingested nephrotoxic substances, 4 presented with dehydration due to vomiting, 4 with chronic excessive dosing (overdose) of acetaminophen, 3 showed pre-existing renal insufficiency, 2 pre-existing liver disease and 2 died with multiple organ failure.


CONCLUSIONS
Renal insufficiency in acetaminophen overdose mostly resolved without dialysis and occurred isolated without hepatotoxicity in less than one-third of the investigated patients. Conditions which might play a role as influencing factors for renal complications included concomitant ingestion of nephrotoxic drugs, dehydration, chronic excessive dosing (overdose) of acetaminophen, pre-existing renal or liver disease and multiple organ failure. Renal function should be monitored in acetaminophen overdose particularly in patients showing the latter comorbidity.
von Mach
M A
MA
Division of Clinical Toxicology and Poison Center, II. Medical Department, University of Mainz, Mainz, Germany. marcm@giftinfo.uni-mainz.de
Hermanns-Clausen
M
M
Koch
I
I
Hengstler
J G
JG
Lauterbach
M
M
Kaes
J
J
Weilemann
L S
LS
D000082:Acetaminophen / Q000009:adverse effects*; D000293:Adolescent; D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems / Q000706:statistics & numerical data; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects*; D062787:Drug Overdose / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D011039:Poison Control Centers / Q000706:statistics & numerical data; D051437:Renal Insufficiency / Q000139:chemically induced / Q000453:epidemiology*
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen