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Acetaminophen

Acetamidophenol


Presentation

  • The 24-year-old patient initially presented with multiple syncopal episodes, hemoptysis and hypoxia. The patient presentation and imaging findings involved in foreign body granulomatosis can mimic many pulmonary disorders and can be widely variable.[ncbi.nlm.nih.gov]
  • The patient reported ingesting "only a couple" of acetaminophen tablets several days prior to her presentation.[ncbi.nlm.nih.gov]
  • A review of the relevant literature is also presented. CONCLUSIONS: Drug-induced acute pancreatitis is often challenging for clinicians and a detailed mechanism is unknown.[ncbi.nlm.nih.gov]
  • A 19-year-old female presents with a one-week history of abdominal pain associated with nausea, vomiting, and headache.[ncbi.nlm.nih.gov]
  • A review of the literature regarding exanthematous drug eruptions secondary to acetaminophen use also is presented.[ncbi.nlm.nih.gov]
Turkish
  • Copyright 2018 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.[ncbi.nlm.nih.gov]
Epigastric Tenderness
  • An examination showed epigastric tenderness. Labs obtained on admission revealed abnormal but improving liver function tests with worsening amylase and lipase.[ncbi.nlm.nih.gov]
Coffee Ground Emesis
  • Two of the 3 children had guaiac-positive coffee-ground emesis after a prolonged period of vomiting, and the remaining child had a blood-streaked stool. The risk of hospitalization with acute gastrointestinal bleeding among all children P .6).[doi.org]
Foreign Body Sensation
  • Any unusual symptoms or signs such as hypernasal speech, chronic nasal infection, or unexplained foreign body sensation in the nose should be thoroughly investigated.[ncbi.nlm.nih.gov]

Workup

  • In addition, itis important for physicians to recognize the increased incidence of pancreatic pseudocyst amongst patients under age 20 with history of DIP, and include pseudocyst in the differential and workup for those presenting with recurrent abdominal[ncbi.nlm.nih.gov]
  • See Workup. Oral activated charcoal avidly adsorbs acetaminophen.[emedicine.medscape.com]
  • Acetaminophen Toxicity Workup. Medscape. Available online at . Updated June 24, 2014. Accessed August 4, 2014. Beauchamp G, et.al. Performance of a Multi-disciplinary Emergency Department Observation Protocol for Acetaminophen Overdose.[labtestsonline.org]

Treatment

  • It is theoretically possible that treatment with MARS administered after NAC will increase the effectiveness of treatment.[ncbi.nlm.nih.gov]
  • The minimum study size was 25 participants per treatment arm at the initial randomisation.[ncbi.nlm.nih.gov]
  • ALT and AST activities were dose-dependently reduced by pyridoxine treatment compared to APAP-treated group. Significant increases in activities of GST and GPx were observed after co-treatment with APAP and pyridoxine.[ncbi.nlm.nih.gov]
  • Increased LC3 and p62 proteins in the liver tissues of APAP-treated mice were decreased by Tβ4 treatment, which indicated the enhancement of autophagy flux by Tβ4.[ncbi.nlm.nih.gov]
  • Numbers of participants achieving each outcome were used to calculate relative risk and numbers needed to treat (NNT) or harm (NNH) compared with placebo or other active treatment.[ncbi.nlm.nih.gov]

Prognosis

  • Specific diagnostic tests should be implemented to identify the cause of ALF, which will help to determine its treatment and prognosis.[doi.org]
  • […] who had inherited two abnormal genes (282YY) was found to have extensive iron loading on liver biopsy Autoimmune hepatitis is an important diagnosis as immunosuppressive drugs (prednisolone and azathioprine) produce lasting remission and an excellent prognosis[doi.org]
  • The prognosis at this state varies. Hepatic Failure — This is characterized as hepatic injury with hepatic encephalopathy, which means that the liver cannot remove toxins from the blood and they will eventually accumulate in the brain.[draxe.com]
  • More on serum phosphate and prognosis of acute liver failure. Hepatology 2003; 38: 533-534. Bernal W, Donaldson N, Wyncoll D, Wendon J. Blood lactate as an early predictor of outcome in paracetamol-induced acute liver failure: a cohort study.[web.archive.org]
  • Lee , Determining prognosis in acute liver failure , Nature Reviews Gastroenterology & Hepatology , 9 , 4 , (192) , (2012) . W.[doi.org]

Etiology

  • Also, drug-induced ALF showed improved outcome compared to other etiologies.[ncbi.nlm.nih.gov]
  • Diagnosis of pyroglutamic acidosis requires both the exclusion of common etiologies of increased anion gap metabolic acidosis and a high index of suspicion.[ncbi.nlm.nih.gov]
  • The disease is divided into several categories based on the underlying etiology, with the drug-induced variant comprising a rising number of the total cases and being reported in association with an increasing number of medications.[ncbi.nlm.nih.gov]
  • It is very important to rule out drug-induced pancreatitis when treating pancreatitis with an unknown etiology. [Indexed for MEDLINE] Free full text[ncbi.nlm.nih.gov]
  • […] toxicity* Anticonvulsants/administration & dosage Anticonvulsants/toxicity* Back Pain/drug therapy* Carbamazepine/administration & dosage Carbamazepine/toxicity* Chemical and Drug Induced Liver Injury/diagnosis Chemical and Drug Induced Liver Injury/etiology[ncbi.nlm.nih.gov]

Epidemiology

  • The only environmental factor that has launched a large and consistent epidemiological signal, found in almost every epidemiological study addressing the issue, is previous acetaminophen exposure, which consistently increases the prevalence and clinical[medscape.com]
  • There is substantial epidemiological evidence in adults and children that acetaminophen use is associated with asthma symptoms.[ncbi.nlm.nih.gov]
  • RESERVATIONS REGARDING EPIDEMIOLOGIC STUDIES Cross-sectional epidemiologic studies can document an association between acetaminophen exposure and asthma, but they cannot prove that acetaminophen causes asthma.[web.archive.org]
Sex distribution
Age distribution

Pathophysiology

  • We present here a 16-year-old girl with renal failure without liver damage because of acetaminophen toxicity and a review of literature for pathophysiological mechanisms, clinical course, treatment, and outcome.[ncbi.nlm.nih.gov]
  • We describe the pathophysiology and discuss the literature on acetaminophen-induced coma and metabolic acidosis in the absence of hepatic injury; and propose mechanisms for associated methemoglobinemia.[ncbi.nlm.nih.gov]
  • […] death induced by acetaminophen (APAP) overdose in animals and humans, more recently an increasing number of publications, especially in the herbal medicine and dietary supplement field, claim an important contribution of apoptotic cell death in the pathophysiology[ncbi.nlm.nih.gov]
  • Several pathophysiological mechanisms are known that could explain this relationship, such as the glutathione pathway, the decrease in the release of Th1 cytokines that are normally produced during febrile episodes, which would then lead to a predominance[ncbi.nlm.nih.gov]

Prevention

  • As NAC is effective in preventing hepatic injury after acute acetaminophen overdose, the role of dialysis or CVVHD is limited.[ncbi.nlm.nih.gov]
  • Ms TS is a 66-year-old woman who receives warfarin for prevention of systemic embolization in the setting of hypertension, diabetes, and atrial fibrillation. She had a transient ischemic attack about 4 years ago when she was receiving aspirin.[ncbi.nlm.nih.gov]
  • To prevent acetaminophen overdose, consumers need to be able to read labels and recognize when their medicines contain acetaminophen.[web.archive.org]
  • The findings indicate that luteolin and quercetin are not likely to be of clinical value for preventing or treating APAP-induced hepatotoxicity. 2017 Royal Pharmaceutical Society.[ncbi.nlm.nih.gov]
  • To recognise patients earlier and prevent severe outcomes, a warning system (clinical rule) based on paracetamol, flucloxacillin and pH measurement may be helpful.[ncbi.nlm.nih.gov]

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