False positive acetaminophen concentrations in patients with liver injury.

  title={False positive acetaminophen concentrations in patients with liver injury.},
  author={J. Polson and F. Wians and P. Orsulak and D. Fuller and N. Murray and J. Koff and Adil I. Khan and J. Balko and L. Hynan and William M. Lee},
  journal={Clinica chimica acta; international journal of clinical chemistry},
  volume={391 1-2},
BACKGROUND Acetaminophen toxicity is the most common form of acute liver failure in the U.S. After acetaminophen overdoses, quantitation of plasma acetaminophen can aid in predicting severity of injury. However, recent case reports have suggested that acetaminophen concentrations may be falsely increased in the presence of hyperbilirubinemia. METHODS We tested sera obtained from 43 patients with acute liver failure, mostly unrelated to acetaminophen, utilizing 6 different acetaminophen… Expand

Paper Mentions

Observational Clinical Trial
The purpose of this study is to collect clinical and epidemiological data as well as serum, plasma, urine, tissue and DNA samples on individuals who have acute liver failure and on… Expand
ConditionsAcute Liver Failure, Acute Liver Injury, Fulminant Hepatic Failure
False positive acetaminophen concentrations in icteric serum
Elevated bilirubin was the most likely candidate to interfere with acetaminophen assay causing false positive results and may be found in icteric serum, when enzymatic-colorimetric assays are used for determination of anacetaminophen concentration. Expand
False-positive paracetamol levels in a patient with hyperbilirubinaemia: clinical perspectives
A new ‘Sliding Scale’ approach to analysis is described, a link between hyperbilirubinemia and false-positive paracetamol levels was identified, and an important interaction for clinicians to be aware of is highlighted. Expand
Pharmacokinetics of Acetaminophen-Protein Adducts in Adults with Acetaminophen Overdose and Acute Liver Failure
The persistence and specificity of APAP-protein adducts as correlates of toxicity support their use as specific biomarkers of AP AP toxicity in patients with acute liver injury. Expand
Falsely Elevated Acetaminophen Levels in the Setting of Hyperbilirubinemia
Review of the literature reveals that falsely elevated APAP levels may rarely occur with patients suffering from liver failure and felt to be related to severe hyperbilirubinemia. Expand
A modified low-cost colorimetric method for paracetamol (acetaminophen) measurement in plasma
A low-cost modified colorimetric paracetamol assay that has the potential to be performed in small laboratories with restricted resources and can be performed rapidly, easily, and economically is assessed. Expand
Elevated acetaminophen level: could it be a red herring?
The diagnosis of aceta-minophen hepatotoxicity was appropriately questioned in this case given the subacute rather than acute clinical presentation, and transaminases less than 20 or more times the upper limit of normal , which is more typical with acetaminophen he-patotoxicity when associated with the degree of synthetic dysfunction experienced by this patient. Expand
Acetaminophen: Pathology and Clinical Presentation of Hepatotoxicity
The chapter reviews the history of acetaminophen, the understanding of its human pharmacology and toxicity, and current approaches and challenges in the recognition and treatment of toxicity in various clinical settings. Expand
A review of acetaminophen poisoning.
Standard courses of N-acetylcysteine may need to be extended in patients with persistently elevated plasma concentrations of acetaminophen or with signs of hepatic injury, and the Rumack-Matthew nomogram is a useful tool to assess risk and guide management. Expand
Susceptibility to acetaminophen (APAP) toxicity unexpectedly is decreased during acute viral hepatitis in mice.
In vitro, hepatocytes from virally infected mice also were resistant to APAP-induced injury but sensitive to NAPQI, and acute viral hepatitis in this model resulted in selective down-regulation of APAP metabolizing P450s in liver and decreased the risk ofAPAP hepatotoxicity. Expand
Effect of hemolysis, icterus, and lipemia on three acetaminophen assays: Potential medical consequences of false positive results.
Hemolysis and icterus had insignificant interference on the Syva EMIT® and the DRI® assays for the analysis of acetaminophen, but significant interference effect on the Roche assay. Expand


False Positive Acetaminophen Levels Associated with Hyperbilirubinemia
Caution must be taken utilizing the GDS Diagnostic assay for the quantification of acetaminophen with concomitant hyperbilirubinemia, and alternatives such as EMIT or GC/MS should be employed to assess acetamophen levels in such patients. Expand
Measurement of serum acetaminophen-protein adducts in patients with acute liver failure.
Measurement of serumacetaminophen-protein adducts reliably identified acetaminophen toxicity, and may be a useful diagnostic test for cases lacking historical data or other clinical information. Expand
False-positive acetaminophen results in a hyperbilirubinemic patient.
The data are consistent with bilirubin interference in the enzymatic and/or chromogenic reactions involved in the acetaminophen method. Expand
Acetaminophen‐induced acute liver failure: Results of a United States multicenter, prospective study
In conclusion, acetaminophen hepatotoxicity far exceeds other causes of acute liver failure in the United States, and education of patients, physicians, and pharmacies to limit high‐risk use settings is recommended. Expand
Acetaminophen poisoning and toxicity.
Although toxicity and fatalities have occurred in the adolescent age group, only one death in younger children has been recorded and the question must be raised as to how many cases of "jaundice of unknown etiology" are actually due to this drug. Expand
Results of a Prospective Study of Acute Liver Failure at 17 Tertiary Care Centers in the United States
The primary aim was to compare presenting clinical features and liver transplantation in patients with acute liver failure related to acetaminophen hepatotoxicity, other drugs, indeterminate factors, and other causes. Expand
Mechanisms of Acetaminophen-Induced Hepatotoxicity: Role of Oxidative Stress and Mitochondrial Permeability Transition in Freshly Isolated Mouse Hepatocytes
Data from mouse hepatocytes used to determine the role of mitochondrial permeability transition (MPT) in acetaminophen (APAP) toxicity are consistent with a hypothesis where APAP-induced cell death occurs by two phases, a metabolic phase and an oxidative phase. Expand
Analysis of the optical properties of bile.
The analysis of pH dependence evidenced the presence of different calibration curves at different pH values: the self-aggregation of the bilirubin molecules observed in pure bile samples was almost totally absent in the gastric samples. Expand