Comment on "Acute ethanol coingestion confers a lower risk of hepatotoxicity after deliberate acetaminophen overdose".

@article{Majlesi2008CommentO,
  title={Comment on "Acute ethanol coingestion confers a lower risk of hepatotoxicity after deliberate acetaminophen overdose".},
  author={N. Majlesi and H. Greller and M. Su and G. Chan},
  journal={Academic emergency medicine : official journal of the Society for Academic Emergency Medicine},
  year={2008},
  volume={15 5},
  pages={
          491-2; author reply 492
        }
}
  • N. Majlesi, H. Greller, +1 author G. Chan
  • Published 2008
  • Medicine
  • Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
OBJECTIVES: Little is known about the clinical significance of acute ethanol coingestion around the time of acetaminophen (paracetamol) overdose. This study prospectively examined the effect of acute ethanol coingestion on risk of hepatotoxicity among patients admitted to hospital for N-acetylcysteine (NAC) therapy after deliberate acetaminophen overdose. METHODS: This was a prospective observational study and included sequential patients who presented within 24 hours of acute acetaminophen… Expand
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References

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Acute ethanol coingestion confers a lower risk of hepatotoxicity after deliberate acetaminophen overdose.
TLDR
Acute ethanol intake is associated with a lower risk of hepatotoxicity after acetaminophen overdose, and this apparent protective effect cannot be explained solely by lower exposure toacetaminophen in this group, nor differences in the interval between ingestion and initiation of treatment. Expand
Acute versus chronic alcohol consumption in acetaminophen‐induced hepatotoxicity
TLDR
It is suggested that patients with chronic alcoholism and suspected acetaminophen poisoning due to an increased risk of developing hepatotoxicity should be treated with NAC regardless of risk estimation. Expand
A risk quantification instrument for acute acetaminophen overdose patients treated with N-acetylcysteine.
TLDR
The risk prediction instrument identifies a large group of low-risk patients for whom 20-hour intravenous N-acetylcysteine therapy is sufficient, and suggests that acute and chronic ethanol use dramatically influences acetaminophen toxicity. Expand
Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose. Analysis of the national multicenter study (1976 to 1985)
TLDR
It is concluded that N-acetylcysteine treatment should be started within eight hours of an acetaminophen overdose, but that treatment is still indicated at least as late as 24 hours after ingestion, and it may be superior when treatment is delayed. Expand
The Effect of Chronic Alcohol Intake on Prognosis and Outcome in Paracetamol Overdose
TLDR
Chronic alcohol intake above suggested limits is an adverse prognostic feature in cases of severe paracetamol overdose and is partly related to increased nephrotoxicity. Expand
Should a Lower Treatment Line Be Used When Treating Paracetamol Poisoning in Patients with Chronic Alcoholism?
A lower threshold for treatment of paracetamol (acetaminophen) poisoning has been advocated in chronic heavy users of alcohol, based originally on animal studies indicating that chronic alcoholExpand
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TLDR
Acute alcohol use resulted in less severe toxic reactions than in those patients without acute alcohol use and those patients with no history of chronic alcohol use, and no consistent difference in hepatotoxicity could be demonstrated. Expand
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TLDR
Intravenous administration of an oral solution of N-acetylcysteine by the intravenous route is associated with a low rate of adverse events and should be considered for selected patients with suspected acetaminophen poisoning. Expand
Acetaminophen Causes an Increased International Normalized Ratio by Reducing Functional Factor VII
TLDR
An isolated, small rise in INR is common after acetaminophen poisoning without hepatic injury and appears to be caused by inhibition of Vitamin K–dependent activation of coagulation factors, which suggests a possible mechanism for the observed interaction betweenacetaminophen and warfarin. Expand
Paracetamol hepatotoxicity and alcohol consumption in deliberate and accidental overdose.
TLDR
It was unable to demonstrate that heavy drinkers develop more severe hepatotoxicity following paracetamol overdose than non-drinkers, and from the material reported in this study, accidental overdose is a better defining term than therapeutic misadventure. Expand
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