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A comprehensive overview of paracetamol poisoning admissions and long-term outcomes in New South Wales, Australia: a retrospective linked data cohort (PAVLOVA-3).

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Generation of a Rat Model of Acute Liver Failure by Combining 70% Partial Hepatectomy and Acetaminophen
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Interventions for paracetamol (acetaminophen) overdose.

Angela L Chiew1, Christian Gluud, Jesper Brok

  • 1Emergency Department and Clinical Toxicology Unit, Prince of Wales Hospital, Barker Street, Randwick, NSW, Australia, 2031.

The Cochrane Database of Systematic Reviews
|February 24, 2018
PubMed
Summary
This summary is machine-generated.

Limited high-quality trials show activated charcoal may reduce paracetamol absorption. Acetylcysteine is recommended for toxicity risk, but more research is needed on optimal regimens and efficacy for paracetamol overdose treatments.

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Area of Science:

  • Toxicology
  • Clinical Pharmacology
  • Evidence-Based Medicine

Background:

  • Paracetamol (acetaminophen) overdose is a common cause of acute liver injury in high-income countries.
  • Interventions for paracetamol poisoning aim to inhibit absorption, remove the drug, or detoxify its metabolites.
  • Treatment strategies vary based on the patient's clinical status.

Purpose of the Study:

  • To assess the benefits and harms of various interventions for paracetamol overdosage.
  • To evaluate treatments irrespective of the cause of overdose.

Main Methods:

  • Systematic review of randomized clinical trials (RCTs) identified through extensive database searches.
  • Data extraction and analysis using fixed-effect and random-effects models.
  • Assessment of risk of bias, trial sequential analysis, and GRADE for evidence quality.

Main Results:

  • Eleven RCTs involving 700 participants were identified, but most were underpowered and at high risk of bias.
  • Activated charcoal showed potential in reducing paracetamol absorption, with unclear clinical benefits.
  • Acetylcysteine appeared superior to some antidotes and may reduce mortality in fulminant hepatic failure, though optimal regimens require further study.

Conclusions:

  • There is a paucity of high-quality RCTs on paracetamol overdose interventions.
  • Activated charcoal may be the best option for reducing absorption if given within four hours.
  • Further rigorous RCTs are needed to establish optimal acetylcysteine regimens and compare different treatment strategies for paracetamol poisoning.