Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- attempted self-harm
- repeated over-the-counter analgesic use for pain relief
- asymptomatic presentation
- nausea, vomiting, or abdominal pain
- right upper quadrant pain and tenderness
- jaundice
- confusion, decreased consciousness level, and/or asterixis
Fatores de risco
- history of self-harm
- history of frequent or repeated use of medications for pain relief
- glutathione deficiency
- increased cytochrome P450 activity
- malnutrition or fasting
- chronic ethanol consumption
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- serum acetaminophen level
- serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT)
Investigações a serem consideradas
- arterial pH and lactate level
- metabolic panel or serum electrolytes with BUN and creatinine
- serum prothrombin time and INR
- serum salicylate level
- ethanol level
- blood glucose level
- lipase level
- serum phosphate
Algoritmo de tratamento
acute single ingestion
repeated supratherapeutic acetaminophen ingestion
Colaboradores
Autores
Hannah Hays, MD, FACEP, FAACT, FACMT
Medical Director
Central Ohio Poison Center
Chief of Toxicology
Nationwide Children’s Hospital
Assistant Professor of Emergency Medicine and Pediatrics
The Ohio State University College of Medicine
Declarações
HH declares that she has no competing interests.
Agradecimentos
Dr. Hannah Hays would like to gratefully acknowledge Dr. Daniel K. Colby, Dr. Alastair Newton, and Professor Allan R. Mottram, previous contributors to this topic. DKC, AN, and ARM declare that they have no competing interests.
Revisores
Scott Phillips, MD
Clinical Faculty
Department of Toxicology
Rocky Mountain Poison & Drug Center
Denver
CO
Declarações
SP declares that he has no competing interests.
Gerald F. O'Malley, DO
Director
Division of Research
Department of Emergency Medicine
Albert Einstein Medical Center
Philadelphia
PA
Declarações
GFOM declares that he has no competing interests.
Sophie Gosselin, MD, FRCPC
Associate Professor
Department of Medicine
McGill University
Emergency Physician and Medical Toxicologist
McGill University Health Centre
Medical Toxicologist
Centre Antipoison du Québec
Montreal
Quebec
Canada
Declarações
SG declares that she is an unpaid co-investigator in the Canadian Acetaminophen Overdose Study and unpaid co-chair of the Extracorporeal Treatment In Poisoning workgroup.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referências
Principais artigos
Dart RC, Mullins ME, Matoushek T, et al. Management of acetaminophen poisoning in the US and Canada: a consensus statement. JAMA Netw Open. 2023 Aug 1;6(8):e2327739.Texto completo Resumo
Fontana RJ, Liou I, Reuben A, et al. AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury. Hepatology. 2023 Mar 1;77(3):1036-65.Texto completo
Chiew AL, Gluud C, Brok J, et al. Interventions for paracetamol (acetaminophen) overdose. Cochrane Database Syst Rev. 2018 Feb 23;(2):CD003328.Texto completo Resumo
American College of Medical Toxicology. ACMT Position statement: duration of intravenous acetylcysteine therapy following acetaminophen overdose. J Med Toxicol. 2017 Mar;13(1):126-7.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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