Procalcitonin (PCT) is commonly employed in medical practice as a diagnostic biomarker of bacterial infection and also as a monitoring biomarker for antimicrobial therapy. There have been a few published reports concerning elevated PCT levels in people with acute liver injury caused by an overdose of acetaminophen. We report here on a case of PCT elevation in an adolescent with acute acetaminophen poisoning without any bacterial infection or liver injury. A 15-year-old girl had deliberately ingested 20 tablets of 650 mg acetaminophen (13 g) and she presented to our emergency department. The PCT level on admission was elevated to 65.64 ng/mL (reference range: 0–0.5 ng/mL). Her PCT level on the second day peaked up to 100 ng/mL and then it gradually decreased. There was no evidence of liver injury or infection on the computed tomography examination and other lab tests. The patient regained her good health and was discharged on the sixth day of hospitalization.
Acetaminophen ; Adolescent ; Bacterial Infections ; Emergency Service, Hospital ; Female ; Hospitalization ; Humans ; Liver ; Poisoning ; Tablets

INTRODUCTIONPaediatric poisoning accounts for 1% of daily emergency department presentations. The aim of this study was to review the characteristics and outcomes of paediatric patients who presented with drug overdose over a five-year period.

METHODSWe performed a retrospective review of paediatric poisoning cases at KK Women's and Children's Hospital (KKH), the largest children's public hospital in Singapore, from 1 January 2009 to 31 December 2013.

RESULTSA total of 1,208 cases of poisoning were seen in KKH's Department of Children's Emergency during the study period. The gender distribution was about equal, with a slight male predominance. The majority of the poisoning cases were accidental. Slightly more than half of the intentional ingestions were of paracetamol and the majority were female patients belonging to the 12-16 year age group. The bulk of poisonings occurred in children aged 1-4 via the oral route, slightly more than half of the oral ingestions consisted of oral medications and a sizeable portion were of household liquids. Mothballs and silica gels accounted for almost a quarter of the solid household products ingested. Slightly less than half of the patients required admission and only a small portion of the admitted patients required intensive or high dependency care.

CONCLUSIONThe prognosis of paediatric patients who presented with poisoning in our study was good, with a short median length of stay for those admitted and no fatalities being reported across the span of five years.

Acetaminophen ; Adolescent ; Adult ; Child ; Child, Preschool ; Critical Care ; Drug Overdose ; epidemiology ; Emergency Service, Hospital ; organization & administration ; Female ; Hospitalization ; Hospitals, Pediatric ; organization & administration ; Humans ; Infant ; Infant, Newborn ; Intensive Care Units ; Length of Stay ; Male ; Poisoning ; epidemiology ; Prognosis ; Retrospective Studies ; Silicon Dioxide ; Singapore ; epidemiology

PURPOSE: On November 15, 2012, sales of OTC (Over-The-Counter) drugs began at convenience stores, which changed the accessibility of some drugs. As a result, the exposure and access patterns of these drugs could have changed. In this study, we reviewed the changes in the characteristics of drug poisoning patients because of the reposition of nonprescription drugs according to the revised Pharmaceutical Affairs Act. METHODS: A retrospective study was conducted to evaluate changes in characteristics of drug poisoning patients between 2008 and 2016. A registry was developed by an emergency medical center in a local tertiary teaching hospital, and patients who visited the center were enrolled in this registry. We compared two periods, from 2008 to 2012 (Pre OTC) and from 2013 to 2016 (Post OTC), for type of intoxicant, time from poisoning to visiting the emergency center, intention, psychiatric history, previous suicidal attempt, alcohol status, and emergency room outcomes. The primary outcome was the number of patients who took acetaminophen and NSAIDs (nonsteroidal anti-inflammatory drugs). Secondary outcomes were ICU admission rate, mortality rate, and number of patients who visited the ER when the pharmacy was closed after taking acetaminophen and NSAIDs (nonsteroidal anti-inflammatory drugs). RESULTS: Among 1,564 patients, 945 and 619 patients visited the emergency room during pre and post OTC periods. The number of patients with acetaminophen and NSAIDs poisoning decreased from 9.2% to 6.1% (p=0.016). The ICU admission rate and mortality rate in the emergency room did not show significant results in the relevant patient groups, and so was the number of patients visiting ER when the pharmacy was closed taking acetaminophen and NSAIDs. CONCLUSION: Despite the sales of nonprescription drugs at convenience stores, the number of acetaminophen and NSAIDs poisoning patients decreased.
Acetaminophen ; Anti-Inflammatory Agents ; Anti-Inflammatory Agents, Non-Steroidal ; Commerce* ; Emergencies ; Emergency Service, Hospital ; Hospitals, Teaching ; Humans ; Intention ; Mortality ; Nonprescription Drugs* ; Pharmacy ; Poisoning ; Retrospective Studies

PURPOSE: The purpose of this study was to determine whether hepatotoxicity could be predicted early using biochemical markers in patients with acetaminophen (AAP) poisoning and to assess the usefulness of predictive factors for acute liver injury or hepatotoxicity. METHODS: This study was a retrospective observational study involving a medical records review. The participants were patients who were admitted to the emergency department (ED) with AAP overdose at two hospitals over a 10-year period. Demographic data, age, time from ingestion to visit, initial AAP level, initial hepatic aminotransferases, and initial prothrombin time were recorded. Acute liver injury was defined as a peak serum ALT >50 U/L or double the admission value, and hepatotoxicity was defined as a peak ALT >1,000 U/L. Receiver operating characteristic curve analyses were performed to compare the prognostic performance among variables. RESULTS: A total of 97 patients were admitted to the ED with AAP overdose, of whom 26 had acute liver injury and 6 had hepatotoxicity. Acute liver injury was associated with the time interval after taking the drug, and hepatotoxicity was associated with the initial PT and the ALT level. The scoring system proposed by the authors has a significant ability to predict both acute liver injury and hepatotoxicity. CONCLUSION: To predict the prognosis of AAP poisoning patients, the time interval after taking AAP was important, and initial prothrombin time and ALT level were useful tests. Also a scoring system combining variables may be useful.
Acetaminophen* ; Biomarkers ; Drug-Induced Liver Injury ; Eating ; Emergency Service, Hospital ; Humans ; Liver ; Medical Records ; Observational Study ; Poisoning* ; Prognosis ; Prothrombin Time ; Retrospective Studies ; ROC Curve ; Transaminases

PURPOSE: The Korean government approved selected nonprescription drugs (Over-The-Counter drug; OTC drug) to be distributed in convenience stores from 15. Nov. 2012. This study examined the changes in the incidence and the clinical outcome of acute pharmaceutical drug poisoning after the deregulation of OTC drug sales. METHODS: This study analyzed the data of Emergency Department based Injury In-depth Injury Surveillance (EDIIS), Korea Centers for Disease Control and Prevention, from 2011 to 2014. The following items were examined: age, gender, intention, alcohol association, pharmaceutical drugs resulting acute poisoning, the clinical outcomes in emergency department, and the admission rate of intensive care unit (ICU). This is a retrospective cross section observational study. RESULTS: A total of 10,162 patients were subject to pharmaceutical drug poisoning. Acute poisoning by acetaminophen and other drugs were 1,015 (10.0%) and 9,147 (90.0%) patients, respectively. After the deregulation of OTC drug sales, acute poisoning by other drugs increased from 4,385 to 4,762 patients but acute poisoning by acetaminophen decreased from 538 to 477 patients (p < 0.05). The rate of admission of acetaminophen poisoning increased from 36.1% (194/538) to 46.8% (223/477). The admission rate to the ICU by acetaminophen poisoning increased from 4.6% (25/538) to 11.3% (54/477) after the deregulation of OTC drug sales (p < 0.05). CONCLUSION: Since the deregulation of OTC drugs sales, pharmaceutical drug poisoning has increased but acetaminophen poisoning has decreased. The rate of hospitalization and ICU admission by pharmaceutical drug poisoning with or without acetaminophen has also increased.
Acetaminophen ; Centers for Disease Control and Prevention (U.S.) ; Commerce* ; Drug Overdose ; Emergencies* ; Emergency Service, Hospital* ; Hospitalization ; Humans ; Incidence ; Intensive Care Units ; Intention ; Korea ; Nonprescription Drugs ; Observational Study ; Poisoning* ; Retrospective Studies

We report on a patient who developed acute hepatic failure despite intravenous N-acetyl cysteine therapy who was treated with the Molecular Adsorbents Recirculating System (MARS). She presented 20 hours after the ingestion of 13 g of acetaminophen. The MARS is based on albumin dialysis principle which can be applied for patients with acute poisoning from drugs that have high protein-binding capacity because of its ability to selectively remove from circulation protein-bound toxins. The clinical toxicologist should be consider this technology when treating patients with hepatic failure following acetaminophen poisoning.
Acetaminophen* ; Cysteine ; Dialysis ; Eating ; Humans ; Liver Failure ; Liver Failure, Acute* ; Mars ; Poisoning

We report on a patient who developed acute hepatic failure despite intravenous N-acetyl cysteine therapy who was treated with the Molecular Adsorbents Recirculating System (MARS). She presented 20 hours after the ingestion of 13 g of acetaminophen. The MARS is based on albumin dialysis principle which can be applied for patients with acute poisoning from drugs that have high protein-binding capacity because of its ability to selectively remove from circulation protein-bound toxins. The clinical toxicologist should be consider this technology when treating patients with hepatic failure following acetaminophen poisoning.
Acetaminophen* ; Cysteine ; Dialysis ; Eating ; Humans ; Liver Failure ; Liver Failure, Acute* ; Mars ; Poisoning

PURPOSE: This study reports the clinical features of children and adolescents treated for acute poisoning at a regional emergency department (ED). METHODS: We retrospectively analyzed children and adolescents (under 19 years) treated for poisoning in an emergency department (ED) from 2003 to 2012. Children range from 0 to 10 years and adolescents range from 11 to 18 years. Demographic data, poisonous material data, treatment, and outcome from poisoning were collected. RESULTS: There were 742 cases of pediatric poisoning during the study period. The distribution of patient ages was bimodal, with two peaks during 1~2 years and 17~18 years of age. The proportion of adolescents with acute poisoning increased from 22.7% (years 2003~2007) to 38% (years 2008~2013). Among children less than 11 years of age, various poisonous agents and therapeutic drugs comprised 43.9% of the total toxic substance subtypes. However, four types of toxic substances dominated among adolescents: acetaminophen, carbon monoxide, corrosives, and psychiatric drugs. Overall, 54.6% of acute intoxicated patients were asymptomatic (17.7% in adolescents). In addition, 25.8% of patients who wer children were not medically treated compared to 2.8% of adolescent patients. Gastric lavage, charcoal usage, and antidote therapy were performed more often in adolescents and enhanced elimination was only performed in adolescents. The discharge rate from the emergency department was 86.8% for children and 69.1% for adolescents. Also, 4.8% of adolescents were admitted into an intensive care unit but no patients died. CONCLUSION: The incidence of adolescent poisoning increased during the period examined. There were many clinical differences in acute poisoning between children and adolescents. Therefore, strategies to cope with acute poisoning according to age group are required.
Acetaminophen ; Adolescent* ; Carbon Monoxide ; Caustics ; Charcoal ; Child* ; Emergencies* ; Gastric Lavage ; Humans ; Incidence ; Intensive Care Units ; Pediatrics ; Poisoning* ; Retrospective Studies*

N-acetylcysteine (NAC) is widely recognized as the antidote of choice for acetaminophen overdose. Acetaminophen is a commonly used analgesic and antipyretic agent, and its use is one of the most common causes of poisoning worldwide. Acetaminophen toxicity may occur acutely when supratherapeutic amounts are ingested purposefully or unintentionally. Liver failure may occur in severe toxicity. However, if treated early, patients with acetaminophen poisoning generally recover uneventfully. Acetaminophen is metabolized to N-acetyl-p-benzoquinone imine (NAPQI), which is detoxified by conjugation with glutathione. In overdose, hepatic stores of glutathione are depleted and NAPQI binding to hepatocytes induces cell death and hepatic necrosis. NAC replenishes hepatic glutathione and may also act as a glutathione substitute, combining directly with the toxic metabolite. Intravenous NAC is indicated in patients who present with a history of acetaminophen overdose within the previous 8 to 10 hours, patients unable to tolerate oral NAC, and patients who present with evidence of fulminant hepatic failure. However, caution should be used in patients who have experienced previous hypersensitivity or anaphylactoid reactions to intravenous NAC, as well as in patients with asthma. The most common anaphylactoid reactions include rash, flushing, and bronchospasm. Adults should receive 150 mg/kg administered for 45 minutes, followed by 50 mg/kg administered for 4 hours, followed by 100 mg/kg administered for 16 hours. The total dose is 300 mg/kg delivered over 21 hours. Additionally, caution should always be used when intravenous NAC is prescribed and the amount of diluent is calculated. Monitoring of patients with a should include repeated neurologic and hemodynamic assessment.
Acetaminophen* ; Acetylcysteine* ; Adult ; Antidotes ; Asthma ; Benzoquinones ; Bronchial Spasm ; Cell Death ; Exanthema ; Flushing ; Glutathione ; Hemodynamics ; Hepatocytes ; Humans ; Hypersensitivity ; Imines ; Liver Failure ; Liver Failure, Acute ; Necrosis ; Poisoning*

Social factors may affect the available sources of toxic substances and causes of poisoning; and these factors may change over time. Additionally, understanding the characteristics of patients with acute toxic poisoning is important for treating such patients. Therefore, this study investigated the characteristics of patients with toxic poisoning. Patients visiting one of 3 hospitals in 2003 and 2011 were included in this study. Data on all patients who were admitted to the emergency departments with acute toxic poisoning were retrospectively obtained from medical records. Total 939 patients were analyzed. The average age of patients was 40.0 +/- 20 yr, and 335 (36.9%) patients were men. Among the elements that did not change over time were the facts that suicide was the most common cause, that alcohol consumption was involved in roughly 1 of 4 cases, and that there were more women than men. Furthermore, acetaminophen and doxylamine remained the most common poisoning agents. In conclusion, the average patient age and psychotic drug poisoning has increased over time, and the use of lavage treatment has decreased.
Acetaminophen/poisoning ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Alcohol Drinking ; Child ; Child, Preschool ; Doxylamine/poisoning ; Emergency Service, Hospital/*statistics & numerical data ; Female ; Hospitals, University ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Poisoning/*epidemiology ; Retrospective Studies ; Sex Factors ; Suicide, Attempted ; Young Adult