Interlaboratory evaluation of salicylate interference in colorimetric acetaminophen methods and its clinical...

Serum specimens with concentrations simulating an overdose of salicylate and acetaminophen were submitted to laboratories participating in an external quality-control program, to evaluate both the magnitude of salicylate interference in colorimetric acetaminophen methods and the clinical significance of the interference. The apparent acetaminophen concentration determined by nitration methods was increased by about 0.70 mg/L per milligram of salicylate per deciliter. Of those laboratories using nitration procedures, 25% do not routinely correct for salicylate and 66% use the (incorrect) correction factor provided by a kit manufacturer. Laboratory data, as they would have been reported to physicians, were used to estimate the acetaminophen half-life and were also applied to a nomogram used to assess the probability of hepatotoxicity. Interference by salicylate in the simulated overdose of 10 g (total dose) of each drug falsely indicated impending hepatic necrosis unless the appropriate correction factor was used. Laboratories using nitration procedures should screen samples submitted for acetaminophen assay for the presence of salicylate and, if present, either use a method specific for acetaminophen or utilize a correction factor determined in-house.