[Paracetamol poisoning--occurrence and treatment].
BACKGROUND
Poisoning with paracetamol is common and potentially serious. We have assessed the incidence of paracetamol poisoning and the hospital's use of serum analyses to monitor the antidotal treatment N-acetyl cysteine.


METHODS
All hospital records of ICD-10 diagnoses T4n and T50.9 at the Department of Acute Medicine from July 2001 to July 2004, were retrospectively reviewed. All cases with possible or confirmed paracetamol poisoning were recorded. Liver damage was defined as ALT above 1,000 U/l. Standard European treatment nomogram was used.


RESULTS
Of 869 admissions with acute poisoning, 158 (21%) were caused by paracetamol; of these 120 (76%) were women and 38 (24%) were men. 107 (68%) of the patients were treated with N-acetyl cysteine at admission due to suspected ingestion of more than 10 grams of paracetamol. Treatment was abrupted in 84 (79%) of the patients, as levels of serum paracetamol were below the treatment line in the nomogram. The median time from admission to sampling was 5 hours. Nine patients (6%), who all arrived later than 15 hours after ingesting paracetamol, developed liver damage. One woman died after a sub-acute overdose of paracetamol.


CONCLUSIONS
Few patients needed treatment with antidote. The treatment seemed to protect all against liver damage if started early. Liver damage and death was associated with admission later than 15 hours after intake.
Aakvik
Rune
R
Akuttmedisinsk avdeling, Medisinsk divisjon, Ullevål universitetssykehus, 0407 Oslo. rune.aakvik@ulleval.no
Jacobsen
Dag
D
D000082:Acetaminophen / Q000097:blood / Q000506:poisoning*; D000111:Acetylcysteine / Q000008:administration & dosage / Q000009:adverse effects; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000097:blood / Q000506:poisoning*; D000931:Antidotes / Q000008:administration & dosage / Q000009:adverse effects; D062787:Drug Overdose; D005260:Female; D006801:Humans; D008099:Liver / Q000187:drug effects / Q000201:enzymology; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D012189:Retrospective Studies; D013997:Time Factors
D018712:Analgesics, Non-Narcotic; D000931:Antidotes; D000082:Acetaminophen; D000111:Acetylcysteine