The importance of paracetamol blood levels on the cost and management of patients with paracetamol overdose

Year 2022, Volume: 39 Issue: 1, 56 - 61, 01.01.2022

Fatih Çalışkan , Hızır Ufuk Akdemir , Ramazan Amanvermez

Abstract

We aimed to evaluate the effect of serum paracetamol level measurement on cost and patient management by evaluating the patients with a history of paracetamol overdose in the emergency department. This study was performed by investigating the data of 175 adult patients admitted to the emergency service after ingestion of the paracetamol-containing drug. Patients were divided into main three groups according to the narrative of ingested amount, and ten subgroups according to the serum paracetamol level, antidote treatment and hospitalization. According to the patients’ narrative, the ingested paracetamol amount was toxic in 97 (55.4%) patients. Serum levels were non-toxic in 50 (28.6%), and toxic in only 4 (2.3%) patients. In intergroup cost analysis, the highest median cost per patient was in Group 4 ($ 332.9 [332.2 – 335.6]), and the lowest median cost per patient was in Group 3 ($ 98.0 [67.1 – 98.0]). When the patient groups in our study were evaluated in terms of cost per patient, there was a statistically significant difference between the groups (p <0.001). Antidote administration, hospitalization and duration of treatment were independent variables affecting cost in our study. One unit increase in antidote administration, hospitalization, and the length of treatment caused to increase in cost about 67.3 units, 56.1 units, 2.2 units, respectively (p<0.001). The treatment cost can be reduced by measuring serum paracetamol levels. For avoiding a potential missed diagnosis of paracetamol overdose the routine measurement of paracetamol level warrants to reduce the cost of the patients who had an ingestion history of unknown paracetamol amount, especially in cases with altered mental status and psychiatric disorder who had suspected/elusive medical anamnesis about drug ingestion.

Keywords

Paracetamol, Ingestion, Level, Management, Cost, Emergency

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