title: Correlation of paired plasma and saliva paracetamol levels following deliberate self-poisoning with paracetamol (the Salivary Paracetamol In Toxicology [SPIT] study).
abstract: OBJECTIVE
  To determine the correlation between plasma and saliva paracetamol levels following paracetamol deliberate self-poisoning.
  
  
  METHODS
  Paired plasma and saliva paracetamol levels were measured. Saliva analysis was performed contemporaneously using a colorimetric method.
  
  
  RESULTS
  21 patients (76% female) mean age 28.3 +/- 12.9 years (range 15-55) were enrolled. Mean reported paracetamol ingestion was 10.3 g (range 2-20 g). Specimens were collected at a mean of 6.2 +/- 3.1 hours post-ingestion (range 4-13 hours) and mean plasma and saliva paracetamol levels were 48 mg/L and 62 mg/L respectively (mean difference 14; 95% CI 5-22; p < 0.004); Pearson's correlation r = 0.95 (p < 0.0001). No patient needing treatment would have been missed using saliva levels only.
  
  
  CONCLUSIONS
  There is concordance between the indications for treatment of paracetamol deliberate self-poisoning based on plasma and saliva paracetamol levels. Saliva paracetamol levels are typically higher than plasma levels. Further studies involving larger numbers of patients, comparing plasma and saliva paracetamol levels in patients with potentially toxic plasma paracetamol concentrations, would be useful in determining the potential clinical value of this method.
authors.affiliation: Royal Perth Hospital, Department of Emergency Medicine, Box X2213 GPO, Perth, 6847 Australia. heidi.wade@health.wa.gov.au
authors.forename: H
authors.initials: H
authors.lastname: Wade
authors.forename: D L
authors.initials: DL
authors.lastname: McCoubrie
authors.forename: D M
authors.initials: DM
authors.lastname: Fatovich
authors.forename: J
authors.initials: J
authors.lastname: Ryan
authors.forename: S
authors.initials: S
authors.lastname: Vasikaran
authors.forename: F F
authors.initials: FF
authors.lastname: Daly
mesh_terms: D000082:Acetaminophen / Q000493:pharmacokinetics / Q000506:poisoning*; D000293:Adolescent; D000328:Adult; D003124:Colorimetry; D062787:Drug Overdose; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012463:Saliva / Q000737:chemistry*; D013406:Suicide, Attempted; D013997:Time Factors
chemical_list: D000082:Acetaminophen