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Sensitivity of dose-estimations for acute acetaminophen overdose in predicting hepatotoxicity risk using the

Summon Chomchai1, Pattaraporn Mekavuthikul1, Jariya Phuditshinnapatra1

  • 1Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Pharmacology Research & Perspectives
|February 2, 2022
PubMed

Insights

In acetaminophen overdose, the 150 mg/kg dose-estimate is a reliable criterion for initiating N-acetylcysteine therapy in resource-poor settings. This approach, combined with activated charcoal and aminotransferase monitoring, effectively manages overdose risks.

Area of Science:

  • Toxicology
  • Emergency Medicine
  • Pharmacology

Background:

  • Acetaminophen overdose management is challenging in resource-limited areas due to delayed concentration assessments.
  • The 150 mg/kg dose-estimate is a common criterion for overdose, but its accuracy against nomogram treatment lines needs evaluation.
  • Evaluating diagnostic accuracy of dose-estimates versus serum concentrations is crucial for timely intervention.

Purpose of the Study:

  • To assess the sensitivity and specificity of acetaminophen dose-estimates (150 mg/kg, 200 mg/kg) against the Rumack-Matthew Nomogram's 150 mg/L treatment line.
  • To compare medical care costs associated with different overdose assessment strategies.
  • To determine the utility of the 150 mg/kg dose-estimate in resource-poor settings for initiating N-acetylcysteine therapy.

Main Methods:

  • Retrospective chart review of 784 acute acetaminophen overdose cases.
  • Analysis of serum acetaminophen levels plotted against the 150 mg/L treatment line on the Rumack-Matthew Nomogram.
  • Evaluation of sensitivity, specificity, and occurrence of hepatotoxicity and acute liver injury (ALI) based on dose-estimates.

Main Results:

  • The 150 mg/kg dose-estimate showed 92.6% sensitivity and 55.3% specificity for the 150 mg/L treatment line.
  • Hepatotoxicity occurred in 7.3% and ALI in 23.9% of cases.
  • Patients with dose-estimates below 150 mg/kg had no hepatotoxicity and 7.1% developed ALI. Activated charcoal reduced risk by half.

Conclusions:

  • The 150 mg/kg dose-estimate is a satisfactory standalone criterion for initiating N-acetylcysteine in resource-poor settings.
  • Combining the 150 mg/kg estimate with activated charcoal and 24-hour aminotransferase monitoring is a practical management strategy.
  • This approach aids timely intervention and potentially reduces healthcare costs in underserved areas.
Keywords:
Rumack-Matthew Nomogramacetaminophenhepatotoxicitypoisoningrisk assessment

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