Acute Acetaminophen Overdose Is Associated with Dose-Dependent Hypokalaemia: A Prospective Study of 331 Patients
| Autor: | Aleks M. Malkowska, Alexandra F. Stephen, W. Stephen Waring, Oliver D. G. Robinson |
|---|---|
| Rok vydání: | 2008 |
| Předmět: |
Adult
Male acetaminophen overdose Antidotes Analgesic Poison control Hypokalemia Toxicology Drug overdose digestive system Statistics Nonparametric Predictive Value of Tests Risk Factors medicine Humans Prospective Studies Antipyretic Prospective cohort study Acetaminophen Pharmacology Dose-Response Relationship Drug business.industry organic chemicals digestive oral and skin physiology General Medicine Analgesics Non-Narcotic Middle Aged medicine.disease digestive system diseases Acetylcysteine Nomograms stomatognathic diseases ROC Curve Anesthesia Vomiting Female Drug Overdose medicine.symptom business medicine.drug |
| Zdroj: | Basic & Clinical Pharmacology & Toxicology. 102:325-328 |
| ISSN: | 1742-7843 1742-7835 |
| DOI: | 10.1111/j.1742-7843.2007.00176.x |
| Popis: | Hypokalaemia is a recognized complication of acute acetaminophen overdose. It is unclear whether this might be a pharmacological effect of acetaminophen, or due to association with confounding factors. The present study sought to better characterize the relationship between acetaminophen concentrations and risk of hypokalaemia. A prospective study of patients received N-acetylcysteine treatment within 15 hr of acute acetaminophen ingestion. Serum potassium concentrations were determined before and after N-acetylcysteine. Serum acetaminophen concentrations were used to indicate overall drug exposure by comparison to the Rumack-Matthew nomogram. Hypokalaemia was pre-defined by serum concentrations3.5 mmol/l, and groups compared by Mann-Whitney tests. There were 331 patients. Median (95% confidence interval) fall in serum potassium concentration after N-acetylcysteine was 0.05 mmol/l (-0.11-0.30 mmol/l) if acetaminophen concentrations were below the 'high-risk' treatment line, 0.30 mmol/l (0.17-0.40 mmol/l) if between the 'high-risk' and 'normal' treatment lines (P = 0.0358), and 0.40 mmol/l (0.20-0.50 mmol/l) if above the 'normal' treatment line (P = 0.0136). A receiver operating characteristic showed that high acetaminophen concentrations were predictive of hypokalaemia (P = 0.0001 versus zero discriminatory line), and 4 hr acetaminophen concentration156 mmol/l gave 81% sensitivity and 48% specificity. The risk of hypokalaemia after acute acetaminophen overdose depends on the extent of acetaminophen exposure, irrespective of N-acetylcysteine administration and independent of whether vomiting occurred. Acetaminophen appears to cause concentration-dependent hypokalaemia after overdose, and the pharmacological basis requires further consideration. |
| Databáze: | OpenAIRE |
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