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Overdose with modified‐release paracetamol ( P anadol O steo®) presenting to a metropolitan emergency medicine network: A case series
Author(s) -
Graudins Andis
Publication year - 2014
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/1742-6723.12249
Subject(s) - medicine , emergency department , acetylcysteine , nomogram , cohort , drug overdose , retrospective cohort study , acetaminophen , anesthesia , emergency medicine , surgery , poison control , biochemistry , chemistry , psychiatry , antioxidant
Background There are currently no large cases series documenting poisoning with paracetamol modified‐release ( P anadol O steo®, G laxo S mith K line, Sydney, NSW , Australia). Management guidelines recommend at least two serum paracetamol concentrations 4 h apart and initiating treatment with N ‐acetylcysteine ( NAC ) if more than 10 g is ingested. Objective To describe a cohort of P anadol O steo® poisoning and determine if the management of identified cases was consistent with existing guidelines. Method Descriptive retrospective case series presenting to a metropolitan hospital network with paracetamol poisoning from O ctober 2009 to S eptember 2013. Results There were 42 cases of P anadol O steo® poisoning identified. Twenty‐nine patients (median ingested dose 19 950 mg) were treated with NAC , of which 27 were acute single ingestions. Of NAC ‐treated patients, 85% (23/27) had an initial serum paracetamol concentration that was above the nomogram line. However, 15% (4/27) had an initial non‐toxic concentration that later increased above the line. In 14 untreated patients (median ingested dose 7980 mg), one was an unrecognised late line‐crosser with initial non‐toxic serum paracetamol concentration. Only 43% (6/14) had a repeat paracetamol concentration measured. Three patients had a 4 h paracetamol >500 μmol/L. Late line‐crossing was seen in the NAC ‐treated group at this level. In two untreated patients, NAC should have been commenced on the reported dose. Conclusion Most patients presenting with P anadol O steo® poisoning requiring NAC treatment had an initial serum paracetamol concentration indicating need for treatment. A small number of late treatment nomogram line‐crossers was seen on repeat paracetamol estimation. The current guideline for P anadol O steo® poisoning would have detected all cases requiring NAC treatment.