Hemoperfusion in "late" paracetamol poisoning

Area of Science:

• Toxicology
• Hepatology
• Critical Care Medicine

Background:

• Paracetamol (acetaminophen) overdose can lead to severe hepatotoxicity.
• Timely administration of N-acetylcysteine (antidote) is crucial for preventing liver damage.
• Patients presenting later than 10 hours post-ingestion may have limited benefit from standard antidotal therapy.

Purpose of the Study:

• To evaluate the efficacy and safety of charcoal hemoperfusion in patients with delayed presentation (>10 hours) after paracetamol overdose.
• To assess the impact of charcoal hemoperfusion on plasma paracetamol concentrations and liver injury markers.

Main Methods:

• Seven patients with paracetamol overdose presenting >10 hours post-ingestion were treated with charcoal hemoperfusion.
• Plasma paracetamol concentrations were monitored before and during hemoperfusion.
• Hepatic transaminase levels (AST) were assessed to evaluate liver damage.

Main Results:

• Charcoal hemoperfusion resulted in a rapid decrease in plasma paracetamol concentrations in all patients.
• The amount of paracetamol removed ranged from 364.5 to 6699 mg.
• One patient died from fulminant hepatic failure; the remaining six recovered with mild hepatic damage (AST < 1000 IU/L).

Conclusions:

• Charcoal hemoperfusion can effectively reduce plasma paracetamol levels even in late-presenting overdose cases.
• This extracorporeal method may mitigate liver injury severity in patients ineligible for specific antidotal treatment.
• Further research is warranted to establish the role of charcoal hemoperfusion in managing severe paracetamol poisoning.