2012-2019 Yılları Arasında Acil Servise Parasetamol İntoksikasyonu ile Başvuran Hastaların Retrospektif Analizi

Year 2019, Volume: 1 Issue: 3, 103 - 108, 28.11.2019

Ömer Faruk Gemiş , Abdullah Osman Koçak

Abstract

Amaç:  Bu
çalışma üçüncü basamak bir acil servis kliniğine kendine zarar verme amacıyla
parasetamol alan hastaların demografik, klinik, tedavi, yan etkiler, laboratuar
verileri gibi bir takım değişkenlerin analizini yapmak amacıyla planlanmıştır.

Gereç
ve Yöntem: Bu çalışma
retrospektif bir çalışmadır. Çalışmamıza 14.01.2012 ile 04.05.2019 tarihleri
arasında Atatürk Üniversitesi Araştırma Hastanesi acil servis polikliniğine
suisid amacıyla parasetamol etken maddeli ilaç alan 18 yaş üstü hastalar dahil
edildi. Veriler hasta dosyaları taranarak elde edildi. Kronik hastalığı
olanlar, gebeler, genel durumu kötü olanlar, eksik verisi olanlar çalışma dışı
bırakıldı.

Bulgular: Çalışmamıza 129 hasta dahil edildi. Hastaların
89’u (%69) kadın cinsiyetteydi. Hastaların yaş ortalaması 25,8 ± 8,6’ydı.
Hastaların yaşları 18-69 arasında değişmekteydi. 43 hasta toksik dozda
parasetamol almıştı. Hastaların aldıkları parasetamol miktarı ile kan
parasetamol düzeyi arasında korelasyon vardı. Alınan parasetamol miktarı ile
diğer kan parametreleri arasında anlamlı ilişki yoktu.

Tartışma: Çalışmamızda alınan parasetamol miktarı ile kan parasetamol düzeyi arasında korelasyon tespit edilmiştir. Ancak karaciğer fonksiyon testlerinde ve Uluslararası Düzeltme Oranı  (INR) değerinde istatistiksel olarak anlamlı bir farklılık gösterilememiştir. Bu konuda daha fazla prospektif çalışmaya ihtiyaç vardır.

Keywords

Asetaminofen, intoksikasyon, karaciğer fonksiyon testleri, INR, parasetamol zehirlenmesi

Retrospective Analysis of Patients Presented With Parasetamol Intoxation to the Emergency Department Between 2012-2019

Abstract

Objective: This study was planned to analyze some variables such as demographic, clinical, treatment, side effects, laboratory data of patients taking paracetamol for self-harm in a tertiary emergency department.

Materials and Methods: This is a retrospective study. Patients over 18 years of age who received paracetamol active substance for suicidal purposes in the emergency department of Atatürk University Research Hospital between 14.01.2012 and 04.05.2019 were included in the study. Patients with chronic disease, pregnant women, patients with poor general condition and missing data were excluded from the study.

Results: 129 patients were included in the study. 89 (69%) of the patients were female. The mean age of the patients was 25.8 ± 8.6 years. The ages of the patients ranged from 18 to 69 years. Forty-three patients had received paracetamol in toxic doses. There was a correlation between the amount of paracetamol and blood paracetamol levels. There was no significant relationship between the amount of paracetamol and other blood parameters.

Conclusion: In our study, there was a correlation between the amount of paracetamol taken and blood paracetamol level. However, there was no statistically significant difference in liver function tests and International Normalized Ratio (INR) values. Further prospective studies are needed.

Keywords

Acetaminophen, intoxication, paracetamol intoxication, INR, liver function tests

References

• 1. Lancaster EM, Hiatt JR, Zarrinpar A. Acetaminophen hepatotoxicity: an updated review. Archives of toxicology, 2015; 89(2): 193-199.
• 2. Antoine DJ, Dear JW, Lewis PS, Platt V, Coyle J, Masson M, Bateman DN. Mechanistic biomarkers provide early and sensitive detection of acetaminophen-induced acute liver injury at first presentation to hospital. Hepatology, 2013; 58(2): 777- 787.
• 3. Park BK, Dear, JW, Antoine DJ. Paracetamol (acetaminophen) poisoning. BMJ clinical evidence, 2015.
• 4. Morgan O, Majeed A. Restricting paracetamol in the United Kingdom to reduce poisoning: a systematic review. Journal of public health, 2004; 27(1): 12-18.
• 5. https://www.uptodate.com/contents/acetaminophen-paracetamol- poisoning-in-adults-pathophysiology-presentation- and-diagnosis?search=acetaminophen-paracetamol-poisoning- in-adults-pathophysiology-presentation-and%20 diagnosis&source=search_result&selectedTitle=1~150&usage_ type=default&display_rank=1
• 6. Rumack BH, Peterson RC, Koch GG, Amara IA. Acetaminophen overdose: 662 cases with evaluation of oral acetylcysteine treatment. Archives of internal medicine, 1981; 141(3): 380-385.
• 7. Makin AJ, Wendon J, Williams R. A 7-year experience of severe acetaminophen-induced hepatotoxicity (1987–1993). Gastroenterology, 1995; 109(6): 1907-1916.
• 8. Lewis RK, Paloucek FP. Assessment and treatment of acetaminophen. Clinical pharmacy, 1991; 10: 765-774.
• 9. Cetaruk E, Horowitz R, Hurlbut K, McDonald F, Dart R. Tylenol Extended Relief overdose: A new headache?. J Toxicol Clin Toxicol, 1995; 33: 511.
• 10. Douglas DR, Sholal JB, Smilkstein MJ. A pharmacokinetic comparison of acetaminophen products (Tylenol Extended Relief vs regular Tylenol). Academic Emergency Medicine, 1996; 3(8): 740-744.
• 11. Whyte IM, Francis B, Dawson AH. Safety and efficacy of intravenous N-acetylcysteine for acetaminophen overdose: analysis of the Hunter Area Toxicology Service (HATS) database. Current medical research and opinion, 2007; 23(10): 2359-2368.
• 12. Penna A, Buchanan N. Paracetamol poisoning in children and hepatotoxicity. British journal of clinical pharmacology, 1991; 32(2): 143-149.
• 13.Acetaminophen (paracetamol) poisoning in adults: Pathophysiology, presentation, and diagnosis: https://www.uptodate.com/contents/acetaminophen-paracetamol- drug-information?search=acetaminophen&source= panel_search_result&selectedTitle=1~148&usage_type= panel&kp_tab=drug_general&display_rank=1
• 14. Acetaminophen Toxicity://emedicine.medscape.com/article/820200-overview# a2
• 15. Isbister GK, Downes MA, Mcnamara K, Berling I, Whyte IM, Page CB. A prospective observational study of a novel 2-phase infusion protocol for the administration of acetylcysteine in paracetamol poisoning. Clinical Toxicology, 2016; 54(2): 120-126.
• 16. Castanares-Zapatero D, Dinant V, Ruggiano I., Willem H, Laterre PF, Hantson P. Pattern of paracetamol poisoning: influence on outcome and complications. Toxics, 2018; 6(4): 58.
• 17. Gunnell D, Hawton K, Murray V, Garnier R, Bismuth C, Fagg J, Simkin S. Use of paracetamol for suicide and non-fatal poisoning in the UK and France: are restrictions on availability justified?. Journal of Epidemiology & Community Health, 1997; 51(2): 175-179.
• 18. Read RB, Tredger JM, Williams R. Analysis of factors responsible for continuing mortality after paracetamol overdose. Human toxicology, 1986; 5(3): 201-206.
• 19. Cairns R, Brown JA, Wylie CE, Dawson AH, Isbister GK, Buckley NA. Paracetamol poisoning-related hospital admissions and deaths in Australia, 2004–2017. Medical journal of Australia, 2019; 211(5): 218-223.
• 20. Whyte IM, Buckley NA, Reith DM, Goodhew I, Seldon M, Dawson AH. Acetaminophen causes an increased International Normalized Ratio by reducing functional factor VII. Therapeutic drug monitoring, 2000; 22(6): 742-748.
• 21. Mateos RS, Hogan NM, Dorcaratto D, Heneghan H, Udupa V, Maguire D, Hoti, E. Total hepatectomy and liver transplantation as a two-stage procedure for fulminant hepatic failure: A safe procedure in exceptional circumstances. World journal of hepatology, 2016; 8(4): 226.