Renal failure is uncommon in Chinese patients with paracetamol (acetaminophen) poisoning

The reported incidence of renal failure in unselected patients with paracetamol poisoning is about 1-2%. Since the introduction of antidotal therapy for paracetamol poisoning in 1973, renal failure is now mainly seen in those admitted too late for effective therapy and is usually associated with liver damage. To determine the incidence of renal failure in Chinese patients with paracetamol poisoning, a retrospective survey was conducted of 224 patients admitted to the Prince of Wales Hospital, Hong Kong, with paracetamol poisoning from January 1988 to January 1994. Of the 28 patients at risk (plasma paracetamol concentrations above the recommended treatment line), 13 developed liver damage which was severe in 5. One patient with severe liver damage developed a transient increase in plasma creatinine concentration from 90 to 116 umol/L. All 28 patients completely recovered. Renal failure was uncommon in Chinese subjects (0.4%), and this was probably related to a lower incidence of liver damage which may be due to less chronic alcoholism as well as ethnic differences in paracetamol metabolism resulting in an inherent reduced susceptibility to its liver and renal toxicity.