Management of acute paracetamol poisoning in a tertiary care hospital.
OBJECTIVE
To compare the management of acute paracetamol poisoning with the best evidence available, and to determine the effect of plasma paracetamol level estimation on the management.


METHODS
Descriptive study with an intervention.


METHODS
Medical wards of the National Hospital of Sri Lanka, Colombo.


METHODS
Patients admitted with a history of acute paracetamol poisoning.


METHODS
Measurement of plasma paracetamol.


METHODS
Data were obtained from the patients, medical staff and medical records. Plasma paracetamol was estimated between 4-24 hours of paracetamol ingestion. The current management practices were compared with the best evidence on acute paracetamol poisoning management.


RESULTS
157 patients were included. The mean ingested dose of paracetamol was 333 mg/kg body weight. Majority of the patients (84%) were transfers. Induced emesis and activated charcoal were given to 91% of patients. N-acetylcysteine was given to 66, methionine to 55, and both to 2. Aclinically important delay in the administration of antidotes was noted; 68% of patients received antidotes after 8 hours of the acute ingestion. Only 31 (26%) had paracetamol levels above the Rumack-Matthew normogram. 74 patients received an antidote despite having a plasma paracetamol level below the toxic level according to the normogram.


CONCLUSIONS
Management of acute paracetamol poisoning could be improved by following best available evidence and adapting cheaper methods for plasma paracetamol estimation.
Senarathna
S M D K G
SM
Department of Pharmacology, Faculty of Medicine, University of Colombo, Sri Lanka. ganga136@yahoo.com
Ranganathan
S Sri
SS
Dawson
A H
AH
Buckley
N
N
Fernandopulle
B M R
BM
D000082:Acetaminophen / Q000097:blood / Q000506:poisoning*; D000111:Acetylcysteine / Q000008:administration & dosage; D000208:Acute Disease; D018712:Analgesics, Non-Narcotic / Q000097:blood / Q000506:poisoning*; D000931:Antidotes / Q000008:administration & dosage; D002606:Charcoal / Q000008:administration & dosage; D004639:Emetics / Q000008:administration & dosage; D019317:Evidence-Based Medicine; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D008715:Methionine / Q000008:administration & dosage; D011041:Poisoning / Q000628:therapy*; D017693:Sodium Bicarbonate / Q000008:administration & dosage; D013188:Sri Lanka; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D018712:Analgesics, Non-Narcotic; D000931:Antidotes; D004639:Emetics; D002606:Charcoal; D000082:Acetaminophen; D017693:Sodium Bicarbonate; D008715:Methionine; D000111:Acetylcysteine