title: [Overdose of modified-release paracetamol calls for changed treatment routines. New guidelines from the Swedish Poisons Information Centre].
abstract: Overdose of modified-release paracetamol calls for changed treatment routines. New guidelines from the Swedish Poisons Information Centre  The sales of modified-release paracetamol tablets are steadily increasing in Sweden as are the number of overdose cases with this formulation. The Swedish Poisons Information Centre has noted that the standard treatment protocol with N-acetylcysteine (NAC), which is based on overdoses with immediate-release paracetamol formulations, is often inadequate in this setting. In this paper, an adult who overdosed on 66.5 grams of modified-release paracetamol tablets and developed severe liver impairment (max ALT 6,660 U/l) despite timely and rigorous NAC treatment is presented. The patient's peak S-paracetamol of 2,800 µmol/l was delayed to 19 hours post-ingestion. Moreover, a pharmacokinetic and clinical study of similar cases showed that seven (21%) of the 34 patients who received NAC treatment within 8 hours after ingestion developed liver impairment. Finally, new Swedish guidelines for management of these cases are presented. The guidelines are also available on www.giftinfo.se.
authors.affiliation: - , Sweden - , Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Höjer
authors.affiliation: Giftinformationscentralen - Stockholm, Sweden Giftinformationscentralen - Stockholm, Sweden.
authors.forename: Helene
authors.initials: H
authors.lastname: Salmonson
authors.affiliation: Giftinformationscentralen - Stockholm, Sweden Giftinformationscentralen - Stockholm, Sweden.
authors.forename: Gunilla
authors.initials: G
authors.lastname: Sjöberg
authors.affiliation: Giftinformationscentralen - Stockholm, Sweden Giftinformationscentralen - Stockholm, Sweden.
authors.forename: Markus
authors.initials: M
authors.lastname: Tellerup
authors.affiliation: Enheten för Effekt och säkerhet 3, Läkemedelsverket - Uppsala, Sweden Enheten för Effekt och säkerhet 3, Läkemedelsverket - Uppsala, Sweden.
authors.forename: Jacob
authors.initials: J
authors.lastname: Brogren
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D000111:Acetylcysteine / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D000931:Antidotes / Q000008:administration & dosage / Q000627:therapeutic use*; D003692:Delayed-Action Preparations / Q000009:adverse effects*; D062787:Drug Overdose / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D011039:Poison Control Centers; D017410:Practice Guidelines as Topic; D013548:Sweden / Q000453:epidemiology
chemical_list: D018712:Analgesics, Non-Narcotic; D000931:Antidotes; D003692:Delayed-Action Preparations; D000082:Acetaminophen; D000111:Acetylcysteine