![]() ![]() This was a retrospective cohort study of all patients admitted for treatment of APAP poisoning to any hospital within our large, community-based hospital system. It was also hypothesized that hospital LOS would be markedly (>24 h) longer than the times of earliest laboratory evidence of clearance (the endpoint of most patient-tailored treatment algorithms). It was hypothesized that LOS would be decreased by early activated charcoal (AC) use, CPCS consultation, early NAC use, and use of intravenous NAC. The aim was to describe the hospital course of patients admitted to our large, community hospital system for treatment of APAP overdose with particular focus on factors influencing hospital length of stay (LOS). This retrospective study was designed to examine the clinical management of admitted APAP poisoning patients by physicians in a community hospital setting. Treatment of patients with chronic or repeated APAP overdose present an even more complicated management problem. Considerable controversy still exists within the toxicology community regarding the proper endpoints for NAC therapy regardless of the route used. The Acetadote package insert recommends a 21-h course of therapy however, this protocol may not be appropriate for all patients with APAP poisoning. In 2004, the US FDA approved an intravenous NAC preparation (Acetadote) giving practitioners another viable treatment option. A shortened-course of oral NAC for selected cases of APAP poisoning has been recommended by practitioners from the California Poison Control System (CPCS) since before 2000, though no routine policy is in place. Most protocols depend on an undetectable serum APAP level and normal (or resolving) liver enzymes as clearance criteria. Though definitive research evidence to “prove” efficacy of these protocols is lacking, many medical toxicologists have adopted these strategies based on anecdotal experiences. These protocols seek to truncate NAC therapy for patients showing evidence of recovery. More recently experts have recommended patient-tailored approaches to oral NAC treatment. The traditional treatment protocol for APAP poisoning in the USA consists of a 72-h course of oral N-acetylcysteine (NAC). Patients presenting with acute APAP overdose are risk stratified based on the Rumack–Matthew nomogram. No studies examining the management of APAP overdose outside of academic medical centers or poison control centers currently exist. Unfortunately, little is known about the clinical management of APAP poisoning cases by community physicians. ![]() CPCS consultation appeared to decrease mean hospital LOS.Īcetaminophen (APAP) overdose is the most common pharmaceutical poisoning reported to poison control centers and remains the number one cause of medication overdose mortality. Use of IV NAC did not impact hospital LOS. Many patients admitted for APAP overdose had serum APAP levels below the minimum toxicity level. ![]() Of 289 cases eligible for placement on the Rumack–Matthew nomogram (acute ingestion with known time of ingestion <24 h and normal liver enzymes), 161 (55.7%) had APAP levels above the “200” line and 77 (26.6%) fell below the “150” line. Eight patients (1.8%) were transferred for liver transplantation, but all of these patients later recovered without transplant. Four hundred thirty-five patients were included. Medical records were abstracted for patient demographic data, key factors of overdose, California Poison Control System (CPCS) contact, data regarding hospital course, transfer for liver transplantation, and death. This was a retrospective cohort study of patients admitted to Kaiser Permanente Northern California hospitals for APAP overdose from July 2003 through December 2007. Factors impacting hospital length of stay (LOS) were of particular interest. The objective of this study was to examine the management of patients admitted for treatment of APAP overdose. Acetaminophen (APAP) overdose is the most common pharmaceutical poisoning. ![]()
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