[Clinical value of estimated half-life in paracetamol poisoning as a complement to Rumack's nomogram].
OBJECTIVE
Rumack's nomogram is usually used to indicate the treatment with N-acetilcysteine in the paracetamol poisoning, but it has several limitations. Paracetamol half-life elimination (t1/2) is approximately of 2 h with therapeutic doses and it increases to more than 4 h in patients with hepatotoxicity. The aim of this study was to determine the usefulness of estimated paracetamol t1/2 as greater than or inferior to 4 h by using a simple ratio in relation to the development of hepatotoxicity.


METHODS
21 patients with paracetamol overdose were admitted to Son Dureta Hospital (Palma de Mallorca) and Clínic Hospital (Barcelona) over 13 months. The estimated t1/2 is calculated using the quotient between 2 plasma paracetamol concentrations separated by 2 or more hours.


RESULTS
We found a significant difference (p < 0.005) between the group with hepatotoxicity (n = 3; t1/2 = 8,5 h; range: 3,6 - 8,7 h); and without hepatotoxicity (n = 18; t1/2 = 2,4 h; (range: 1,6 - 4,3 h). We observed an agreement between positive ratio and a t1/2 > 4 h, and negative ratio with t1/2 < 4 h, bearing in mind that the quotient is obtained through mathematical equations.


CONCLUSIONS
Rumack's nomogram should be complemented with t1/2 estimation in all cases of paracetamol poisoning, especially with those patients for whom we are not able to determine the time of ingestion at presentation or if there has been a multiple-timepoint ingestion.
Castanyer-Puig
Bartomeu
B
Unidad de Toxicología Clínica, Servicio de Análisis Clínicos, Hospital Son Dureta. Palma de Mallorca, Islas Baleares, España. tcastanyer@hsd.es
Barceló-Martín
Bernardí
B
Puiguriguer-Ferrando
Jordi
J
Rovira-Illamola
Marina
M
Soy-Muner
Dolors
D
Nogué-Xarau
Santiago
S
D000082:Acetaminophen / Q000378:metabolism* / Q000506:poisoning*; D000328:Adult; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology* / Q000378:metabolism*; D062787:Drug Overdose; D005260:Female; D006207:Half-Life; D006801:Humans; D008297:Male; D049451:Nomograms; D011237:Predictive Value of Tests
D000082:Acetaminophen