Reliability of the reported ingested dose of acetaminophen for predicting the risk of toxicity in acetaminophen overdose patients
Date Published:
2012
Citation-Indexed Journal:
Pharmacoepidemiology and Drug Safety. Volume 21, Issue 2, February 2012, Pages 207-213
Citation:
Reliability of the reported ingested dose of acetaminophen for predicting the risk of toxicity in acetaminophen overdose patients
Authors:
Zyoud, S.H.,
Awang, R.,
Sulaiman, S.A.S.
Awang, R.,
Sulaiman, S.A.S.
Abstract:
Purpose:
The present study examines the relationship between the dose of acetaminophen reported to have been ingested by patients and the occurrence of serum acetaminophen levels above the 'possible toxicity' line in patients presenting at the hospital after acetaminophen overdose. The prognostic value of patient-reported dosage cut-offs of 8, 10 and 12g was determined.
Methods:
This retrospective cohort study included patients admitted to the emergency department or hospital within 24 hours of acetaminophen ingestion. Serum acetaminophen concentrations were considered to be the gold standard, and specificity, sensitivity and positive/negative predictive values were calculated from the reported ingested dose, to predict toxicity using the Rumack-Matthew nomogram (i.e. the 'possible toxicity' treatment line) and standard equations.
Results:
Of 305 patients identified, 291 met the study inclusion criteria, and 121 (41.6%) had serum acetaminophen concentrations above the 'possible toxicity' treatment line. The range of patient-reported acetaminophen ingested was 1-75g, with 185 patients (63.6%) reporting =8g. One hundred eighteen patients (97.5%) who reported ingesting =8g had serum acetaminophen concentrations above the '150-line', compared with only three patients (2.5%) who reported ingesting Conclusions:
Patient-reported doses of acetaminophen are good risk indicators for acetaminophen overdose patients in Malaysia. Patient-reported ingestion of =8g (as a cut-off dose) had a higher sensitivity than =10g or =12g. The results of this study have important implications for toxicity risk evaluations in areas with poor serum acetaminophen assay availability.
The present study examines the relationship between the dose of acetaminophen reported to have been ingested by patients and the occurrence of serum acetaminophen levels above the 'possible toxicity' line in patients presenting at the hospital after acetaminophen overdose. The prognostic value of patient-reported dosage cut-offs of 8, 10 and 12g was determined.
Methods:
This retrospective cohort study included patients admitted to the emergency department or hospital within 24 hours of acetaminophen ingestion. Serum acetaminophen concentrations were considered to be the gold standard, and specificity, sensitivity and positive/negative predictive values were calculated from the reported ingested dose, to predict toxicity using the Rumack-Matthew nomogram (i.e. the 'possible toxicity' treatment line) and standard equations.
Results:
Of 305 patients identified, 291 met the study inclusion criteria, and 121 (41.6%) had serum acetaminophen concentrations above the 'possible toxicity' treatment line. The range of patient-reported acetaminophen ingested was 1-75g, with 185 patients (63.6%) reporting =8g. One hundred eighteen patients (97.5%) who reported ingesting =8g had serum acetaminophen concentrations above the '150-line', compared with only three patients (2.5%) who reported ingesting Conclusions:
Patient-reported doses of acetaminophen are good risk indicators for acetaminophen overdose patients in Malaysia. Patient-reported ingestion of =8g (as a cut-off dose) had a higher sensitivity than =10g or =12g. The results of this study have important implications for toxicity risk evaluations in areas with poor serum acetaminophen assay availability.
