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News & Views
New Diagnostic Test Could Help Prevent Paracetamol Overdose Deaths
A doctor can only work with what he knows.
When someone takes a variety of medications that leads to unintentional paracetamol overdose, he or she may not be able to inform doctors about the specifics of the drug intake, leaving A&E staff short of the one detail that could lead to immediate and effective treatment.
But now scientists have designed a test that reveals paracetamol overdose, giving A&E doctors a new tool to help save lives.
Following the thread
In previous e-Alerts, I told you the story of Marcus Trunk, a young man who took paracetamol to address the pain from a sprained wrist. When Marcus developed a fever and began vomiting, he went to his local hospital. Doctors thought he had the flu and gave him more paracetamol. In less than a week, Marcus died of acute liver failure (ALF) due to unintentional paracetamol overdose.
To prevent further outcomes like Marcus Trunks, scientists have developed a new method for determining paracetamol overdose by examining blood samples for traces of chemical byproducts produced by toxic levels of the drug.
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 paracetamol-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. Paracetamol toxicity markers were detected in all of the patients with well-defined paracetamol-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 paracetamol 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 paracetamol toxicity testing method is based on widely available technology. Hopefully thats not just hype and this test really does have a future as a common A&E tool.
The need for such a tool is all the more pressing because a study published earlier this year showed that unintentional overdose with paracetamol is the most common cause of acute liver failure in the United Kingdom. Paracetamol is also the single biggest cause of ALF in the US. According to a study published last year, cases have been rising for the last six years, and by 2003 paracetamol accounted for just over half the cases of ALF, and about half of these were the result of accidental overdoses.
In past e-Alerts Ive noted that FDA estimates put unintentional paracetamol overdoses in the US at more than 14,000 per year, with about 100 of those cases resulting in death. But the Reuters Health article about Dr Daverns 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 US.
The Reuters article doesnt 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.
Paracetamol is present in a vast number of over-the- counter medications for coughs, colds, sneezing, headaches, muscles aches, back pain and the like, including products for children and babies. One of the best ways to reduce overdoses and fatalities is to get the word out and let people know that paracetamol needs to be taken with great care. So if youll tell a friend, and your friend tells a friend, and that friend tells a friend
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