Low rates of hepatotoxicity among Asian patients with paracetamol overdose: a review of 1024 cases
Open Access
- 28 September 2012
- journal article
- review article
- Published by Springer Science and Business Media LLC in BMC Pharmacology and Toxicology
- Vol. 13 (1), 8
- https://doi.org/10.1186/2050-6511-13-8
Abstract
Background The metabolism of paracetamol in Asians is thought to differ from Westerners. Detailed clinical features of paracetamol -induced hepatotoxicity among Asians remains largely unreported. Methods A retrospective review of adult cases with paracetamol overdose over a five-year duration was performed in two of the largest public institutions in this country. Prevalence and predictive factors for hepatotoxicity were determined. Results Data on 1024 patients (median age 23 years, 82.0% female, ethnic groups: Malays 40.8%, Chinese 20.9% , Indian 33.2%) were obtained from January 2005 to December 2009. The median amount of paracetamol ingestion was 10.0 (IQR 5.0 - 15.0) g and the median serum paracetamol level was 274.80 (IQR 70.0 - 640.0) μmol/L at presentation. 75 (7.3%) patients developed hepatotoxicity. 23/ 55 (41.8%) patients who had ingested > 10 g of paracetamol and had a delayed (> 24 hour) administration of N-acetyl cystine (NAC) developed hepatotoxicity. No patients developed acute liver failure nor suffered any mortality (0%). Independent predictors for hepatotoxicity were identified as Malay (OR 2.22, 95% CI = 1.13-4.37) and Chinese (OR 3.26, 95% CI = 1.55-6.84) ethnicity, paracetamol dose > 10 g (OR 2.61, 95% CI = 1.53-4.46), prolonged duration of time from paracetamol ingestion to hospital presentation (> 24 hours OR 10.71, 95% CI = 3.46-33.15) and prolonged duration of time from paracetamol ingestion to NAC administration (> 24 hours OR 9.02, 95% CI = 2.97-27.45). Conclusions Paracetamol-induced hepatotoxicity rates in a multi-ethnic Asian population was low at 7.3%. Mortality and morbidity were non-existent despite high doses of paracetamol ingestion and delayed presentations to hospital.Keywords
This publication has 26 references indexed in Scilit:
- A cost effectiveness analysis of the preferred antidotes for acute paracetamol poisoning patients in Sri LankaBMC Clinical Pharmacology, 2012
- Acetaminophen-Associated Hepatic Injury: Evaluation of Acetaminophen Protein Adducts in Children and Adolescents With Acetaminophen OverdoseClinical Pharmacology & Therapeutics, 2008
- Does the patient history predict hepatotoxicity after acute paracetamol overdose?QJM: An International Journal of Medicine, 2008
- Acute liver failure: Summary of a workshopJournal of Hepatology, 2007
- Acetaminophen-induced acute liver failure: Results of a United States multicenter, prospective studyJournal of Hepatology, 2005
- Paracetamol overdose and hepatotoxicity at a regional Australian hospital: a 4‐year experienceInternal Medicine Journal, 2005
- Paracetamol, alcohol and the liverBritish Journal of Clinical Pharmacology, 2000
- Use of paracetamol for suicide and non-fatal poisoning in the UK and France: are restrictions on availability justified?Journal of Epidemiology and Community Health, 1997
- Paracetamol Self-Poisoning Characteristics, Prevention and Harm ReductionThe British Journal of Psychiatry, 1996
- Variability of acetaminophen metabolism in Caucasians and OrientalsPharmacogenetics, 1992