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Acetaminophen-induced hypotension in sepsis.

Shunsuke Inage1, Ryo Yajima2, Shintaro Nagahara2

  • 1Department of Pharmaceutical Services, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 1138603, Japan. shunsukeinage@nms.ac.jp.

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Acetaminophen significantly increased hypotension risk in sepsis patients compared to IVIG, even with mannitol in both. Further research is needed on mannitol

Keywords:
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Area of Science:

  • Critical care medicine
  • Pharmacology
  • Clinical research

Background:

  • Acetaminophen-induced hypotension is a concern in critically ill patients.
  • The role of mannitol, an excipient in acetaminophen formulations, in hemodynamic changes is not well understood.
  • This study investigates acetaminophen's direct effect on blood pressure in sepsis.

Purpose of the Study:

  • To compare blood pressure changes after acetaminophen versus intravenous immunoglobulin (IVIG) administration in sepsis patients.
  • To identify risk factors for hypotension following acetaminophen.
  • To assess the influence of mannitol in acetaminophen formulations on hemodynamics.

Main Methods:

  • Retrospective cohort study at Nippon Medical School Hospital.
  • Included adult sepsis patients with continuous arterial blood pressure monitoring who received IV acetaminophen or IVIG.
  • Propensity score matching was used to create comparable groups.

Main Results:

  • Hypotension occurred in 58.0% of acetaminophen recipients versus 36.9% of IVIG recipients (OR=8.26).
  • In propensity score-matched cohorts, hypotension incidence was 67.5% with acetaminophen and 37.5% with IVIG (OR=7.21).
  • Acetaminophen administration was associated with a significantly higher risk of hypotension.

Conclusions:

  • Acetaminophen induced substantially greater hypotension than IVIG in sepsis patients.
  • Both drugs contained mannitol, suggesting acetaminophen itself, not solely mannitol, contributes to hypotension.
  • Further investigation is required to elucidate the hemodynamic effects of mannitol in acetaminophen formulations.