Should a Lower Treatment Line Be Used When Treating Paracetamol Poisoning in Patients with Chronic Alcoholism?

@article{Buckley2002ShouldAL,
  title={Should a Lower Treatment Line Be Used When Treating Paracetamol Poisoning in Patients with Chronic Alcoholism?},
  author={Nicholas A Buckley and Jayasri Srinivasan},
  journal={Drug Safety},
  year={2002},
  volume={25},
  pages={619-624}
}
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 alcohol ingestion increased hepatotoxicity. This was attributed to increased production of the toxic metabolite, N-acetyl-p-benzoquinoneimine, by cytochrome P450 (CYP)2E1 induction. The clinical evidence for increased risk is limited to four retrospective studies with potential for referral and reporting bias… 

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

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Investigation into the effect of acute ethanol coingestion on risk of hepatotoxicity among patients admitted to hospital for N-acetylcysteine (NAC) therapy after deliberate acetaminophen overdose finds an apparent protective effect, but further work is required to establish mechanisms by which ethanol might confer protection against hepatot toxicity.

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Criteria for acetylcysteine treatment and clinical outcomes after paracetamol poisoning

  • W. Waring
  • Medicine
    Expert review of clinical pharmacology
  • 2012
TLDR
The different indications for acetylcysteine used by the UK and USA would result in similar numbers of patients treated, although the criteria would define patients with different characteristics and patterns of overdose.

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TLDR
Acetaminophen appears to cause concentration-dependent hypokalaemia after overdose, and the pharmacological basis requires further consideration.

Acetaminophen Intoxication and Length of Treatment: How Long Is Long Enough?

TLDR
The evidence that supports reducing the course of N‐acetylcysteine therapy from 72 hours to 24 or 36 hours is critically evaluated and offers important benefits for both the patient and the patient's family, such as increased drug tolerability and reduced hospital stay.

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TLDR
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TLDR
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TLDR
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TLDR
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TLDR
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