Management of acetaminophen toxicity, a review

Acetaminophen (APAP) is a widely used drug in our environment with few adverse effects. Because of this, several patients affected by APAP hepatotoxicity unknown that the APAP dose-intake was excessive. This damage is mainly produced via one of APAP metabolites: N-acetyl-para-benzo-quinone imine (NA...

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Autores principales:	Alejandra Beltrán-Olazábal, Patricia Martínez-Galán, Rubén Castejón-Moreno, Miren Edurne García-Moreno, Cristina García-Muro, Eduardo Esteban-Zubero
Formato:	article
Lenguaje:	EN
Publicado:	Emergency Department of Hospital San Pedro (Logroño, Spain) 2019
Materias:	acetaminophen toxicity hepatotoxicity apap paracetamol acute liver failure Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/0e852f7d890f4dfd86235ad87d70b528
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spelling	oai:doaj.org-article:0e852f7d890f4dfd86235ad87d70b5282021-12-02T18:13:43ZManagement of acetaminophen toxicity, a review10.5281/zenodo.34702622695-5075https://doaj.org/article/0e852f7d890f4dfd86235ad87d70b5282019-10-01T00:00:00Zhttps://doi.org/10.5281/zenodo.3470262https://doaj.org/toc/2695-5075Acetaminophen (APAP) is a widely used drug in our environment with few adverse effects. Because of this, several patients affected by APAP hepatotoxicity unknown that the APAP dose-intake was excessive. This damage is mainly produced via one of APAP metabolites: N-acetyl-para-benzo-quinone imine (NAPQI), which is very toxic. The drug’s ingested doses as well as the length of time from APAP ingestion to N-acetylcysteine (NAC) therapy are the most essential determining factors in both the development and severity of APAP hepatotoxicity. However, there are other factors related, including alcohol intake, herbs and medications, age and genetic factors, nutritional status, and chronic liver disease. The ingestion of a toxic dose of APAP causes different clinical manifestations that depend fundamentally on the time elapsed since the intake. The diagnosis process depends on the intake (acute single overdose of after repeated overdoses). The Rumack-Matthew nomogram is acceptable after an acute single overdose, being the “possible hepatic toxicity” point 200 μg/mL at 4 hours and 25 μg/mL at 16 hours). This normogram is no applicable in after repeated overdoses. NAC is the antidote for APAP intoxication, and could be administered orally or intravenous. Finally, a multidisciplinary approach with the support of Psychiatry, Intensive Care Unit as well as Gastroenterology and Digestive Department will be necessary, especially in the case of attempted autolysis and severe liver failure.Alejandra Beltrán-OlazábalPatricia Martínez-GalánRubén Castejón-MorenoMiren Edurne García-MorenoCristina García-MuroEduardo Esteban-ZuberoEmergency Department of Hospital San Pedro (Logroño, Spain)articleacetaminophen toxicityhepatotoxicityapapparacetamolacute liver failureMedicine (General)R5-920ENIberoamerican Journal of Medicine, Vol 1, Iss 1, Pp 22-28 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	acetaminophen toxicity hepatotoxicity apap paracetamol acute liver failure Medicine (General) R5-920
spellingShingle	acetaminophen toxicity hepatotoxicity apap paracetamol acute liver failure Medicine (General) R5-920 Alejandra Beltrán-Olazábal Patricia Martínez-Galán Rubén Castejón-Moreno Miren Edurne García-Moreno Cristina García-Muro Eduardo Esteban-Zubero Management of acetaminophen toxicity, a review
description	Acetaminophen (APAP) is a widely used drug in our environment with few adverse effects. Because of this, several patients affected by APAP hepatotoxicity unknown that the APAP dose-intake was excessive. This damage is mainly produced via one of APAP metabolites: N-acetyl-para-benzo-quinone imine (NAPQI), which is very toxic. The drug’s ingested doses as well as the length of time from APAP ingestion to N-acetylcysteine (NAC) therapy are the most essential determining factors in both the development and severity of APAP hepatotoxicity. However, there are other factors related, including alcohol intake, herbs and medications, age and genetic factors, nutritional status, and chronic liver disease. The ingestion of a toxic dose of APAP causes different clinical manifestations that depend fundamentally on the time elapsed since the intake. The diagnosis process depends on the intake (acute single overdose of after repeated overdoses). The Rumack-Matthew nomogram is acceptable after an acute single overdose, being the “possible hepatic toxicity” point 200 μg/mL at 4 hours and 25 μg/mL at 16 hours). This normogram is no applicable in after repeated overdoses. NAC is the antidote for APAP intoxication, and could be administered orally or intravenous. Finally, a multidisciplinary approach with the support of Psychiatry, Intensive Care Unit as well as Gastroenterology and Digestive Department will be necessary, especially in the case of attempted autolysis and severe liver failure.
format	article
author	Alejandra Beltrán-Olazábal Patricia Martínez-Galán Rubén Castejón-Moreno Miren Edurne García-Moreno Cristina García-Muro Eduardo Esteban-Zubero
author_facet	Alejandra Beltrán-Olazábal Patricia Martínez-Galán Rubén Castejón-Moreno Miren Edurne García-Moreno Cristina García-Muro Eduardo Esteban-Zubero
author_sort	Alejandra Beltrán-Olazábal
title	Management of acetaminophen toxicity, a review
title_short	Management of acetaminophen toxicity, a review
title_full	Management of acetaminophen toxicity, a review
title_fullStr	Management of acetaminophen toxicity, a review
title_full_unstemmed	Management of acetaminophen toxicity, a review
title_sort	management of acetaminophen toxicity, a review
publisher	Emergency Department of Hospital San Pedro (Logroño, Spain)
publishDate	2019
url	https://doaj.org/article/0e852f7d890f4dfd86235ad87d70b528
work_keys_str_mv	AT alejandrabeltranolazabal managementofacetaminophentoxicityareview AT patriciamartinezgalan managementofacetaminophentoxicityareview AT rubencastejonmoreno managementofacetaminophentoxicityareview AT mirenedurnegarciamoreno managementofacetaminophentoxicityareview AT cristinagarciamuro managementofacetaminophentoxicityareview AT eduardoestebanzubero managementofacetaminophentoxicityareview
_version_	1718378435652354048

Management of acetaminophen toxicity, a review

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