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HOME > J Korean Soc Clin Toxicol > Volume 4(2); 2006 > Article
Is N-acetylcysteine Treatment Based on Ingestion Amount Valid in Acute Acetaminophen Overdose Patients?
Tae-Geun Kim, Min-Joung Kim, Jin-Hee Lee, Sung-Pil Chung, Hahn-Shick Lee, Yoo-Seok Park
Journal of The Korean Society of Clinical Toxicology 2006;4(2):107-112
DOI: https://doi.org/
Published online: December 31, 2006
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1Department of Emergency Medicine, Yonsei University College of Medicine
2Department of Emergency Medicine, Yonsei University College of Medicine
3Department of Emergency Medicine, Yonsei University College of Medicine
4Department of Emergency Medicine, Yonsei University College of Medicine
5Department of Emergency Medicine, Yonsei University College of Medicine
6Department of Emergency Medicine, Yonsei University College of Medicine

Purpose: In many Korean hospitals, serum acetaminophen concentrations in cases of overdose cannot be measured initially because of inadequate laboratory facilities. Under these circumstances, physicians base the administration of the antidote, N-acetylcysteine, on ingestion amounts as determined by initial history taking. We therefore examined the correlated between ingested amounts and serum acetaminophen concentrations. Methods: Medical records were reviewed retrospectively for patients who presented to the ED with acetaminophen overdose between January 2002 and March 2006. Fifty-nine patients were recruited and sixteen patients were excluded. The forty-three remaining patients were placed into either the high-risk or low-risk group based on their ingested amount (140 mg/kg), and were separately categorized into the toxic or non-toxic group based on their serum acetaminophen concentrations, according to the Rurnack-Matthew nomogram. Results: Ten patients (83.3%) among twelve in the high-risk group were found to have non-toxic serum concentrations, and just one patient (3.2%) among thirty-one in the low-risk group fell into the toxic group based on their serum concentrations. The sensitivity and specificity of risk stratification of the ingested amount as a predictor of intoxication requiring antidote therapy were 66.7% and 75.0%, respectively. Conclusion: This study suggests that the therapeutic decision for acetaminophen overdose should not be based solely on ingested amount only, but requires assessment of acetaminophen concentration.

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JKSCT : Journal of The Korean Society of Clinical Toxicology