Pediatr 2002 May;140(5):522-6
Predictors of outcome after acetaminophen poisoning in children and
adolescents.
James LP, Wells E, Beard RH, Farrar HC
Division of Pediatric Clincial Pharmacology, University of Arkansas for
Medical Sciences, Little Rock, 72205, USA.
OBJECTIVE: Shortened courses of N-acetylcysteine may be acceptable in
patients with acetaminophen poisoning who are at low risk for toxicity. The
goal of this study was to determine which clinical findings best identified
patients at lowest risk for acetaminophen-related hepatotoxicity after an
acute overdose.
STUDY DESIGN: This was a retrospective analysis, throughout
10 years, of hospital admissions for acute acetaminophen poisoning, with
inclusion criteria being an acetaminophen concentration above the possible
toxicity line by nomogram, arrival within 24 hours, and an initial
prothrombin time (PT), aspartate aminotransferase (AST), and alanine
aminotransferase (ALT) measured within 24 hours of ingestion. Clinical
parameters capable of identifying patients most and least likely to have
hepatotoxicity were evaluated by using sensitivity and specificity testing.
RESULTS: Of 95 patient charts identified, 41 met all inclusion criteria,
with 16 patients having hepatotoxicity. PT, AST, and ALT within the first 24
hours postingestion did not identify all patients who had hepatotoxicity.
The best predictor of a low risk of toxicity was the presence of normal
values for the PT, AST, or ALT within 48 hours of ingestion.
CONCLUSIONS: These data suggest that all patients with an acute acetaminophen overdose should be observed and treated for at least 48 hours postingestion.
PMID: 12032516, UI: 22028378
(L411/bf)
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