title: Serum Acetaminophen Protein Adduct Concentrations in Pediatric Emergency Department Patients.
abstract: Acetaminophen toxicity is a common cause of pediatric liver failure. The diagnosis may be limited by the short window of detection of acetaminophen in serum. Recently acetaminophen protein adducts (APAP-CYS) have been used as a biomarker with a longer duration of detection. The objective of this study was to describe the serum concentrations of APAP-CYS in pediatric patients with and without reported therapeutic acetaminophen exposure.
  
  
  
  A cross-sectional study of children age 1 to <12 years presenting to a pediatric emergency department. Subjects were stratified by recent acetaminophen use and had serum APAP-CYS measured using LC/MS.
  
  
  
  One hundred patients were enrolled. All of the patients whose caregivers denied acetaminophen exposure had nondetectable APAP-CYS. Fifty-two percent of subjects who were reported to have taken acetaminophen in the preceding 2 weeks had detectable serum APAP-CYS. The APAP-CYS concentrations were positively correlated with higher overall dose and more recent ingestion.
  
  
  
  APAP-CYS is detectable in the majority of children taking acetaminophen and not detected in the majority of children who are not exposed to acetaminophen.
authors.affiliation: *Department of Emergency Medicine, Division of Medical Pharmacology and Toxicology, University of Colorado School of Medicine, Aurora †Rocky Mountain Poison and Drug Center ‡Department of Emergency Medicine, Denver Health and Hospitals, Denver, CO.
authors.forename: Kennon
authors.initials: K
authors.lastname: Heard
authors.forename: Victoria
authors.initials: V
authors.lastname: Anderson
authors.forename: Richard C
authors.initials: RC
authors.lastname: Dart
authors.forename: Deidre
authors.initials: D
authors.lastname: Kile
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Lavonas
authors.forename: Jody L
authors.initials: JL
authors.lastname: Green
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects / Q000097:blood*; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D056486:Chemical and Drug Induced Liver Injury / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003545:Cysteine / Q000097:blood*; D062787:Drug Overdose / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012016:Reference Values
chemical_list: D018712:Analgesics, Non-Narcotic; D015415:Biomarkers; C043967:acetaminophen-cysteine conjugate; D000082:Acetaminophen; D003545:Cysteine