Haemoperfusion in 'late' paracetamol poisoning

Area of Science:

• Toxicology
• Pharmacology
• Hepatology

Background:

• Paracetamol overdose is a common cause of acute liver injury.
• Timely administration of N-acetylcysteine is crucial for effective treatment.
• Limited options exist for patients presenting beyond the window for antidotal therapy.

Purpose of the Study:

• To evaluate the efficacy of charcoal haemoperfusion in patients with delayed paracetamol overdose.
• To assess the impact of charcoal haemoperfusion on plasma paracetamol concentrations and liver injury.

Main Methods:

• Seven patients with paracetamol overdose presenting later than 10 hours post-ingestion were treated.
• Charcoal haemoperfusion was employed as the primary intervention.
• Plasma paracetamol concentrations and liver enzymes (AST) were monitored.

Main Results:

• Rapid reduction in plasma paracetamol concentrations was observed in all treated patients.
• Significant amounts of paracetamol were removed via haemoperfusion, ranging from 364.5 mg to 6699 mg.
• One patient developed fulminant hepatic failure and died; the remaining six recovered with mild hepatic damage (AST < 1000 iu/L).

Conclusions:

• Charcoal haemoperfusion can effectively reduce plasma paracetamol levels even in late-presenting overdose cases.
• This method may mitigate the severity of liver injury in patients not eligible for standard antidotal therapy.
• Further research is warranted to establish the role of charcoal haemoperfusion in paracetamol poisoning management.