The impact of updated national guidelines for managing unintentional paediatric liquid paracetamol exposures: a retrospective poisons centre study.

IF 3 3区 医学 Q2 TOXICOLOGY
Clinical Toxicology Pub Date : 2024-11-01 Epub Date: 2024-10-28 DOI:10.1080/15563650.2024.2412203
Sook Har Ong, Amy B Thomson, Nicole E Wright, Una Nic Ionmhain, Darren M Roberts
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引用次数: 0

Abstract

Introduction: In 2015, Australia and New Zealand treatment guidelines recommended a 2 h paracetamol serum concentration for risk assessment of unintentional paracetamol liquid exposures. We assess our experience with this approach.

Methods: Retrospective case review of children <6 years-old with liquid paracetamol overdoses referred to a regional poisons information centre January 2017 to August 2022. We extracted data on the exposure and management from the poisons information centre and hospital medical records. We identified additional cases with two paracetamol concentrations obtained from September 2022 to June 2024.

Results: Of 437 paediatric poisonings, 271 were eligible for inclusion. The median age was 24 months, the median time to presentation was 120 min, and paracetamol was the sole ingestant in 92% of cases. Blood testing was recommended in 131 patients (48.3%), occurring at 2 h post-ingestion in 62 patients (47.3%). Testing at a later time was mostly due to delayed presentation, including to hospitals unable to measure paracetamol concentrations. Eighteen patients (16.7%) had repeat blood testing, and five additional cases were identified in the subsequent period. Overall, the concentration decreased in 19 patients (83%), but in three patients it increased, from 73 mg/L to 81 mg/L (0.49-0.54 mmol/L), from 154 mg/L to 179 mg/L (1.03-1.19 mmol/L), and from 56 mg/L to 115 mg/L (0.37-0.77 mmol/L). Symptomatic patients were more likely to receive a second blood test or acetylcysteine while awaiting investigations. Of 19 patients administered acetylcysteine, it was discontinued in five due to low paracetamol serum concentrations. All patients recovered.

Discussion: Guidelines were followed in >90% of patients and this testing regimen shortened length of stay. Based on these data, Australian treatment guidelines now recommend repeat testing for 2 h paracetamol serum concentrations >100 mg/L (0.67 mmol/L).

Conclusion: A paracetamol serum concentration between 2 h and 4 h post-ingestion in children <6 years-old with unintentional poisonings of paracetamol liquid can facilitate medical discharge.

管理儿童意外接触液体扑热息痛的最新国家指导方针的影响:一项毒物中心回顾性研究。
简介:2015 年,澳大利亚和新西兰治疗指南建议采用扑热息痛 2 小时血清浓度来评估意外接触扑热息痛液体的风险。我们对采用这种方法的经验进行了评估:方法:对儿童病例进行回顾性分析:在 437 例儿童中毒事件中,有 271 例符合纳入条件。中位年龄为 24 个月,中位发病时间为 120 分钟,92% 的病例中扑热息痛是唯一的摄入物。建议对 131 名患者(48.3%)进行血液检测,其中 62 名患者(47.3%)在进食后 2 小时进行了检测。在较晚时间进行检测主要是由于患者就诊时间延迟,包括医院无法测量扑热息痛的浓度。18 名患者(16.7%)进行了重复血液检测,随后又发现了 5 例患者。总体而言,19 名患者(83%)的扑热息痛浓度有所下降,但有 3 名患者的浓度有所上升,分别从 73 毫克/升升至 81 毫克/升(0.49-0.54 毫摩尔/升)、从 154 毫克/升升至 179 毫克/升(1.03-1.19 毫摩尔/升)和从 56 毫克/升升至 115 毫克/升(0.37-0.77 毫摩尔/升)。有症状的患者更有可能在等待检查期间接受第二次血液检测或服用乙酰半胱氨酸。在接受乙酰半胱氨酸治疗的 19 名患者中,有 5 人因扑热息痛血清浓度过低而停药。所有患者均已康复:讨论:超过 90% 的患者遵循了指南,这种检测方案缩短了住院时间。基于这些数据,澳大利亚的治疗指南现在建议对 2 小时内扑热息痛血清浓度>100 毫克/升(0.67 毫摩尔/升)的患者进行重复检测:结论:儿童在进食后 2 小时至 4 小时内的扑热息痛血清浓度应低于 100 毫克/升(0.67 毫摩尔/升)。
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来源期刊
Clinical Toxicology
Clinical Toxicology 医学-毒理学
CiteScore
5.70
自引率
12.10%
发文量
148
审稿时长
4-8 weeks
期刊介绍: clinical Toxicology publishes peer-reviewed scientific research and clinical advances in clinical toxicology. The journal reflects the professional concerns and best scientific judgment of its sponsors, the American Academy of Clinical Toxicology, the European Association of Poisons Centres and Clinical Toxicologists, the American Association of Poison Control Centers and the Asia Pacific Association of Medical Toxicology and, as such, is the leading international journal in the specialty.
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