title: A modified low-cost colorimetric method for paracetamol (acetaminophen) measurement in plasma.
abstract: BACKGROUND
  Despite a significant increase in the number of patients with paracetamol poisoning in the developing world, plasma paracetamol assays are not widely available. The purpose of this study was to assess a low-cost modified colorimetric paracetamol assay that has the potential to be performed in small laboratories with restricted resources.
  
  
  METHODS
  The paracetamol assay used in this study was based on the Glynn and Kendal colorimetric method with a few modifications to decrease the production of nitrous gas and thereby reduce infrastructure costs. Preliminary validation studies were performed using spiked aqueous samples with known concentrations of paracetamol. Subsequently, the results from the colorimetric method for 114 stored clinical samples from patients with paracetamol poisoning were compared with those from the current gold-standard high-performance liquid chromatography method. A prospective survey, assessing the clinical use of the paracetamol assay, was performed on all patients with paracetamol poisoning attending the Peradeniya General Hospital, Sri Lanka, over a 10-month period.
  
  
  RESULTS
  The recovery study showed an excellent correlation (r(2) > 0.998) for paracetamol concentrations from 25 to 400 mg/L. The final yellow color was stable for at least 10 min at room temperature. There was also excellent correlation with the high-performance liquid chromatography method (r(2) = 0.9758). In the clinical cohort study, use of the antidote N-acetylcysteine was avoided in over a third of patients who had the plasma paracetamol concentration measured. The cost of consumables used per assay was $0.50 (US).
  
  
  CONCLUSIONS
  This colorimetric paracetamol assay is reliable and accurate and can be performed rapidly, easily, and economically. Use of this assay in resource-poor clinical settings has the potential to have a significant clinical and economic impact on the management of paracetamol poisoning.
authors.affiliation: South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka. shihana@sactrc.org
authors.forename: Fathima
authors.initials: F
authors.lastname: Shihana
authors.forename: Dhammika
authors.initials: D
authors.lastname: Dissanayake
authors.forename: Paul
authors.initials: P
authors.lastname: Dargan
authors.forename: Andrew
authors.initials: A
authors.lastname: Dawson
mesh_terms: D000082:Acetaminophen / Q000097:blood* / Q000506:poisoning; D000111:Acetylcysteine / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000097:blood* / Q000506:poisoning; D000931:Antidotes / Q000627:therapeutic use; D002138:Calibration; D002851:Chromatography, High Pressure Liquid; D015331:Cohort Studies; D003124:Colorimetry / Q000191:economics / Q000379:methods; D006801:Humans; D007202:Indicators and Reagents; D011446:Prospective Studies; D015203:Reproducibility of Results; D013188:Sri Lanka
chemical_list: D018712:Analgesics, Non-Narcotic; D000931:Antidotes; D007202:Indicators and Reagents; D000082:Acetaminophen; D000111:Acetylcysteine