Acetaminophen overdose

Full Disclosure

A doctor can only work with what he knows.

When someone takes a variety of medications that leads to unintentional acetaminophen overdose, he may not be able to inform doctors about the specifics of his drug intake, leaving ER personnel short of the one detail that could lead to immediate and effective treatment.

But now scientists have designed a test that reveals acetaminophen overdose, giving ER doctors a new tool to help save lives.

Following the thread

In previous e-Alerts I’ve told you the story of Marcus Trunk, a young man who took acetaminophen to address the pain from a sprained wrist. When Marcus developed a fever and began vomiting, he went to a hospital near his home in Philadelphia. Doctors thought he had the flu and gave him more acetaminophen. In less than a week, Marcus died of acute liver failure (ALF) due to unintentional acetaminophen overdose .

To prevent further outcomes like Marcus Trunk’s, scientists have developed a new method for determining acetaminophen overdose by examining blood samples for traces of chemical byproducts produced by toxic levels of acetaminophen.

A team of researchers led by Dr. Timothy J. Davern II of the University of California at San Francisco, recently tested this new method with a cohort of more than 80 subjects divided into four groups:

• 20 patients with well-defined acetaminophen-related ALF
• 10 patients with ALF from other well defined causes
• 36 patients with ALF from unknown causes
• 15 patients with acetaminophen overdose, but minimal liver injury

The results were very promising. Acetaminophen toxicity markers were detected in all of the patients with well-defined acetaminophen-related ALF, and in none of the patients with ALF unrelated to the drug.

Among the 36 ALF patients with unknown causes, seven blood tests indicated that acetaminophen contributed to ALF. This result indicates that acetaminophen overdose may be even greater than previously thought, according to Dr. Davern in an interview with Reuters Health.

Tell all!

Dr. Davern told Reuters Health that the acetaminophen toxicity testing method is based on widely available technology. Hopefully that’s not just hype and this test really does have a future as a common emergency room tool.

The need for such a tool is all the more pressing because it appears that acetaminophen overdose is on the rise. In past e-Alerts (most recently in “Safety Squandered” 2/23/06) I’ve noted that FDA estimates put unintentional acetaminophen overdoses in the U.S. at more than 14,000 per year, with about 100 of those cases resulting in death. But the Reuters Health article about Dr. Davern’s research sets those numbers much higher: more than 56,000 emergency room visits due to acetaminophen toxicity and nearly 500 deaths each year in the U.S.

The Reuters article doesn’t make the distinction between deaths due to intentional or unintentional overdoses. Nevertheless, the message is clear: This is a dangerous drug when taken in high doses.

One of the best ways to reduce overdoses and fatalities is to get the word out and let people know that acetaminophen needs to be taken with great care. So if you’ll tell a friend, and your friend tells a friend, and that friend tells a friend

Sources:
“Measurement of Serum Acetaminophen-Protein Adducts in Patients With Acute Liver Failure” Gastroenterology, Vol. 130, No. 3, March 2006, us.elsevierhealth.com
“Test Spots Acetaminophen-Related Liver Toxicity” David Douglas, Reuters Health, 4/12/06, reutershealth.com