Clinical Toxicology最新文献

{"title":"Echocardiographic and clinical patterns in patients with acute carbon monoxide poisoning without cardiovascular and other chronic diseases.","authors":"Jarosław Szponar, Sylwia Goliszek, Anna Kujawa, Michał Tchórz, Anna Sutkowska, Anna Radoniewicz-Tchórz, Piotr Danielewicz, Agnieszka Witkowska, Anna Krajewska, Magdalena Majewska, Lidia Aftyka, Jarosław Bakiera","doi":"10.1080/15563650.2025.2456689","DOIUrl":"10.1080/15563650.2025.2456689","url":null,"abstract":"<p><strong>Introduction: </strong>Severe carbon monoxide may impact the circulatory system, potentially leading to myocardial injury. This study aimed to assess left ventricular function via echocardiography in patients with acute carbon monoxide poisoning who were otherwise healthy.</p><p><strong>Methods: </strong>We conducted an observational, single-centre study involving consecutive patients hospitalized with carbon monoxide poisoning.</p><p><strong>Results: </strong>In a study of 112 consecutive patients with acute carbon monoxide poisoning, we identified a subset of 46 patients with moderate to severe poisoning. Among them, myocardial injury (defined by a peak high-sensitivity troponin T concentration >14.0 ng/L) was observed in 17 of 46 (36.9%) patients, forming the myocardial injury group. The remaining 29 patients formed the non-myocardial injury group. The echocardiographic assessment revealed no significant difference (<i>P</i> = 0.06) between the mean (±SD) left ventricular ejection fraction in the myocardial injury group (59.8 ± 5.4%), compared to the mean (±SD) in the non-myocardial injury group (62.9 ± 5.5%). However, the mean (±SD) left ventricular global longitudinal strain was significantly higher (<i>P</i> = 0.008) in the myocardial injury group (-20.1 ± 1.8%) compared to the non-myocardial injury group (-22.1 ± 2.4%). Patients in the myocardial injury group also exhibited significantly higher (<i>P</i> <0.001) mean heart rates (108.9 beats/min) compared to the non-myocardial injury group (87.6 beats/min). In addition, the mean plasma lactate concentration was significantly higher (<i>P</i> <0.001) in the myocardial injury group (1.95 mmol/L) compared to the non-myocardial injury group (1.2 mmol/L). There were no fatalities in either group.</p><p><strong>Discussion: </strong>Healthy patients with carbon monoxide poisoning who have myocardial injury may show minor changes in echocardiography in contrast to patients with co-morbidities.</p><p><strong>Conclusions: </strong>In patients with moderate to severe carbon monoxide poisoning, without concurrent chronic diseases, left ventricular global longitudinal strain was significantly lower in those with myocardial injury. However, these findings are based on a small cohort, necessitating further research.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"246-252"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative analysis of recreational psychoactive mushroom gummies in Portland, Oregon.","authors":"Matthew S Correia, Mikayla J Gonzaga, Courtney Temple, Roy R Gerona","doi":"10.1080/15563650.2025.2450240","DOIUrl":"10.1080/15563650.2025.2450240","url":null,"abstract":"<p><strong>Introduction: </strong>In November 2020, Oregon passed Measures 109 and 110 altering the legal landscape for psychoactive substances by regulating psilocybin use and decriminalizing possession of Schedule I substances. This coincided with the growth of the commercial nootropic (cognitive enhancers) mushroom industry, including products such as mushroom gummies marketed for \"legal highs.\" Despite these product claims, concerns have been raised about their safety profile. Our study aimed to assess the accuracy of labeling of these products and quantify their psychoactive contents.</p><p><strong>Methods: </strong>Eight gummy products were procured from seven different smoke and vape shops in Portland, Oregon. Gummy samples were homogenized and analyzed using liquid chromatography coupled with quadrupole time-of-flight mass spectrometry. Products were screened for psychoactive compounds, including psilocybin, psilocin, and their analogues, as well as for purported <i>Amanita muscaria</i> derivatives. Quantitative analysis of identified compounds was performed using isotope dilution.</p><p><strong>Results: </strong>Neither ibotenic acid nor muscimol, the active components of <i>Amanita muscaria</i>, were detected in the two products claiming to contain <i>Amanita muscaria</i> extracts. However, these products contained psilocin and tryptamine derivatives. One product labeled as psilocybin-free tested positive for psilocybin. Another sample claiming to be nootropic contained undisclosed Δ9-tetrahydrocannabinol. Overall, seven of the eight products contained psilocin, and six contained 4-acetoxy-N,N,dimethyltryptamine. Other detected compounds included various tryptamine congeners and kavalactones.</p><p><strong>Discussion: </strong>Labeling was inaccurate and inconsistent in many of the products examined. Users are likely to experience psychoactive symptoms considering the concentrations of xenobiotics determined. Serotonergic effects are expected from products containing tryptamine derivatives, including those inaccurately labeled as containing <i>Amanita muscaria</i> extracts.</p><p><strong>Conclusions: </strong>The labeling of psychoactive mushroom gummies we tested was overall inaccurate. Products suggesting <i>Amanita muscaria</i> content instead contained serotonergic tryptamines, including some which falsely claimed to be free of psilocybin.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"261-266"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authors' reply to comment on Cole et al. \"Comparison of children receiving extracorporeal treatments for poisoning at United States centers with and without a pediatric nephrologist\".","authors":"Jon B Cole, Anne M Kouri, Joshua D King, Travis D Olives, Nathaniel L Scott, Carrie L Oakland","doi":"10.1080/15563650.2025.2483385","DOIUrl":"10.1080/15563650.2025.2483385","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"300-301"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of children receiving extracorporeal treatments for poisoning at United States centers with and without a pediatric nephrologist.","authors":"Jon B Cole, Anne M Kouri, Joshua D King, Travis D Olives, Nathaniel L Scott, Carrie L Oakland","doi":"10.1080/15563650.2025.2456109","DOIUrl":"10.1080/15563650.2025.2456109","url":null,"abstract":"<p><strong>Background: </strong>Pediatric nephrologists are rare in the United States; many children with poisoning needing extracorporeal treatments may not have timely access to care. This study compared outcomes in children receiving extracorporeal treatments for poisoning at centers with and without a pediatric nephrologist.</p><p><strong>Methods: </strong>This was a retrospective cohort study of all patients aged ≤17 years reported to an American poison center covering three upper midwestern states during 2000-2024.</p><p><strong>Results: </strong>We identified 72 patients: 54 received extracorporeal treatments at a hospital with pediatric nephrologists, and 18 patients aged 14-17 years (minimum weight, 35 kg) received extracorporeal treatments at hospitals staffed solely by adult nephrologists. The most common responsible poisons were toxic alcohols (10/18, 55%) and salicylates (4/18, 22%). Children receiving extracorporeal treatments from adult nephrologists more commonly (<i>P</i> <0.001) received intermittent hemodialysis (18/18, 100%) compared to pediatric nephrologists (31/54, 57%). Conversely, children treated by pediatric nephrologists more commonly (<i>P</i> <0.05) received continuous kidney replacement therapy (28/54, 52%) compared to adult nephrologists (0/18). We found no difference (<i>P</i> = 0.1) in mortality between the children treated by pediatric nephrologists (9/54, 17%) compared to those treated by adult nephrologists (0/18).</p><p><strong>Discussion: </strong>Teenage children commonly received hemodialysis from adult nephrologists for poisoning and had similar outcomes to those treated by pediatric nephrologists.</p><p><strong>Conclusions: </strong>These data suggest adult nephrologists can successfully perform extracorporeal treatments for poisoning in teenage children.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"292-295"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of acetylcysteine on the prothrombin time and international normalized ratio: a narrative review.","authors":"Messia Nazar, Jenny E Kootstra-Ros, Paola Mian, Daniel J Touw, Marieke G G Sturkenboom","doi":"10.1080/15563650.2025.2451642","DOIUrl":"10.1080/15563650.2025.2451642","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Patients poisoned with paracetamol are treated with acetylcysteine. In patients without hepatocellular injury, an increased prothrombin time or international normalized ratio has been observed during acetylcysteine administration. The international normalized ratio is preferred as it is a standardized calculation of prothrombin time independent of reagents and machinery. Since the prothrombin time and international normalized ratio are used as markers of liver injury in patients with paracetamol poisoning, it is important to assess the magnitude of the effect of acetylcysteine treatment on the prothrombin time and international normalized ratio. The aim of this narrative review is to describe the effect of acetylcysteine on the prothrombin time and international normalized ratio.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Embase, PubMed and Web of Science were searched to identify the effect of acetylcysteine on coagulation factors II, VII, IX or X, the prothrombin time and the international normalized ratio in &lt;i&gt;in vitro&lt;/i&gt; and &lt;i&gt;in vivo&lt;/i&gt; studies in healthy subjects and clinical studies involving both those poisoned with paracetamol and surgical patients. The search terms employed were acetylcysteine combined with prothrombin time, international normalized ratio, coagulation or haemostasis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The search identified a total of 2,471 articles, of which 19 studies were included. Six &lt;i&gt;in vitro&lt;/i&gt; and/or &lt;i&gt;in vivo&lt;/i&gt; studies, five clinical studies in paracetamol-poisoned patients and eight clinical studies in surgical patients were included. Acetylcysteine caused a 15-30% increase in prothrombin time and international normalized ratio. This increase was dose-dependent and was caused by a decrease in the activity of coagulation factors II, VII, IX and X. The effect of acetylcysteine on the increased prothrombin time and international normalized ratio was more prominent after the high loading dose but remained present during the lower maintenance dose of acetylcysteine. The effect was observed in both &lt;i&gt;in vitro&lt;/i&gt; and &lt;i&gt;in vivo&lt;/i&gt; studies and confirmed in clinical studies in paracetamol-poisoned patients without hepatic injury. Studies in surgical patients treated with acetylcysteine showed conflicting results. Twelve of the 13 clinical studies suffered from risk of bias, limiting the value of these studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The moderate 15-30% increase in the international normalized ratio induced by acetylcysteine is especially important in hospitals using the international normalized ratio as a marker for hepatotoxicity due to paracetamol poisoning and underlines the need for the international normalized ratio to be assessed at admission.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Acetylcysteine treatment leads to an estimated 15-30% increase in prothrombin time and international normalized ratio in both experimental studies and paracetamol-poisoned patients. Isolated incr","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"166-175"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Veno-venous extracorporeal membrane oxygenation (VV-ECMO) for acute poisonings in United States: a retrospective analysis of the Extracorporeal Life Support Organization Registry.","authors":"Hong K Kim, Andrew O Piner, Lauren N Day, Kevin M Jones, Danilo Alunnifegatelli, Matteo Di Nardo","doi":"10.1080/15563650.2024.2447496","DOIUrl":"10.1080/15563650.2024.2447496","url":null,"abstract":"<p><strong>Introduction: </strong>Veno-arterial extracorporeal membrane oxygenation is frequently considered and implemented to help manage patients with cardiogenic shock from acute poisoning. However, utilization of veno-venous extracorporeal membrane oxygenation in acutely poisoned patients is largely unknown.</p><p><strong>Method: </strong>We conducted a retrospective study analyzing the epidemiologic, clinical characteristics and survival of acutely poisoned patients placed on veno-venous extracorporeal membrane oxygenation using the Extracorporeal Life Support Organization registry. Adult cases in the United States were included after a systematic search of the registry between January 1, 2003, and November 30, 2019. Study outcomes included survival to discharge, time to cannulation, and changes in metabolic, hemodynamic, and ventilatory parameters stratified by survival.</p><p><strong>Results: </strong>One hundred and seventeen cases were included in the analysis after excluding 216 non-poisoning-related cases. Their median age was 34 years and 69.2% were male. Opioids (45.3%) were most commonly implicated, followed by neurologic drugs (e.g., antidepressants, antiepileptics) (14.5%) and smoke inhalation (13.7%); 23 patients (19.7%) had a pre-extracorporeal membrane oxygenation cardiac arrest. The median time from admission to extracorporeal membrane oxygenation was 47 h with a median duration of extracorporeal membrane oxygenation support of 146.5 h. Survivors were cannulated significantly earlier than non-survivors (25 h versus 123 h; <i>P</i> = 0.02). Eighty-four patients (71.2%) survived to hospital discharge. Clinical parameters (hemodynamic, metabolic, and ventilatory) improved with veno-venous extracorporeal membrane oxygenation support, but no statistically significant difference was noted between survivors and non-survivors.</p><p><strong>Discussion: </strong>Our study showed that veno-venous extracorporeal membrane oxygenation was infrequently utilized for poisoning-associated acute respiratory distress syndrome. Opioids were the most frequently reported exposure among the cases in which indirect lung injury may have occurred from aspiration. Although no specific clinical parameters were associated with survival, early initiation of extracorporeal membrane oxygenation may improve clinical outcomes.</p><p><strong>Conclusions: </strong>The use of veno-venous extracorporeal membrane oxygenation for refractory respiratory failure due to poisoning was associated with a clinically significant survival benefit compared to other respiratory diagnoses requiring veno-venous extracorporeal membrane oxygenation.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"204-211"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presence of sibutramine and sildenafil in weight loss dietary supplements: a case series with analytical and clinical investigation.","authors":"Marie Carles, Tessa Pietri, Joelle Micallef, Clara Corteggiani-Giraud, Magali Richez, Caroline Solas-Chesneau, Bruno Lacarelle, Nicolas Fabresse","doi":"10.1080/15563650.2025.2452297","DOIUrl":"10.1080/15563650.2025.2452297","url":null,"abstract":"<p><strong>Introduction: </strong>The use of weight loss supplements is increasing, often driven by online marketing. However, many of these supplements are adulterated with undeclared pharmaceutical substances, potentially posing significant health risks. We investigated the presence of sibutramine and sildenafil in weight loss supplements and assessed the associated clinical outcomes.</p><p><strong>Materials and methods: </strong>A total of 12 weight loss supplement samples (capsules, tea, and coffee bags) were analyzed using liquid chromatography-high resolution mass spectrometry. Demographic and clinical data were collected by the Marseille Regional Pharmacovigilance Centre from 29 patients who reported using these products.</p><p><strong>Results: </strong>All samples were found to contain sibutramine, with concentrations ranging from 7.5 mg to 15.4 mg per unit. Sildenafil was detected in all samples, with concentrations ranging from 1.7 mg to 4.8 mg per unit. Clinical data from 29 users showed significant weight loss, with an average of 7.5 kg after 37 days of use. Adverse effects included anorexia (<i>n</i> = 15), tachycardia (<i>n</i> = 13), insomnia (<i>n</i> = 2) and chest pain (<i>n</i> = 4). In some cases, more serious effects such as seizures and dependence were observed.</p><p><strong>Discussion: </strong>Both sibutramine and sildenafil were withdrawn from the market due to cardiovascular risks. As such, the unregulated use of these products pose a serious risk to public health, particularly in individuals with underlying cardiovascular disease.</p><p><strong>Conclusion: </strong>We detected sibutramine and sildenafil in all 12 weight loss supplements tested, which highlights the need for stricter regulation and monitoring.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"193-195"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety profile of antivenom in a cohort of patients envenomed by <i>Deinagkistrodon acutus</i> in Hangzhou, Zhejiang Province, Southeast China.","authors":"Mengyun Tu, Tao Yu, Yuchen Shen, Sipin Hu","doi":"10.1080/15563650.2025.2449938","DOIUrl":"10.1080/15563650.2025.2449938","url":null,"abstract":"<p><strong>Introduction: </strong>Antivenom treatment is the specific treatment for <i>Deinagkistrodon acutus</i> envenomation. However, safety concerns regarding the use of antivenom in this population have been reported only infrequently in the literature. We aimed to determine the incidence of anaphylactic reactions and serum sickness following antivenom administration in a cohort of patients envenomed by <i>Deinagkistrodon acutus</i>.</p><p><strong>Methods: </strong>We retrospectively reviewed the medical records of patients admitted to the Hangzhou TCM Hospital between January 2018 and December 2022 with bites from <i>Deinagkistrodon acutus</i>. The information collected included patient demographics, clinical information, laboratory findings, details of antivenom use, use of premedications, and details of anaphylactic reactions and serum sickness.</p><p><strong>Results: </strong>A total of 157 patients with bites from <i>Deinagkistrodon acutus</i> were treated with antivenom (median dose four vials) and were included in the study. All treated patients received premedications (dexamethasone and antihistamines). Adverse reactions were noted in 18 patients (11.5%). Ten of these individuals (6.4%) suffered anaphylactic reactions within the first 24 h following antivenom administration, categorized as mild (<i>n</i> = 5), moderate (<i>n</i> = 4), or severe (<i>n</i> = 1). Symptoms included rash, urticaria, diaphoresis, nausea, dyspnoea, wheezing, anaphylactic shock, loss of consciousness, and angioedema. Serum sickness occurred in eight patients (5.1%), manifesting primarily as urticaria or erythematous rash, fever, myalgia, arthralgia, malaise, and gastrointestinal symptoms.</p><p><strong>Discussion: </strong>This study provided data on adverse reactions associated with antivenom administration in patients admitted with bites from <i>Deinagkistrodon acutus</i> admitted to a regional referral centre specializing in the management of patients with severe or complex health conditions in Zhejiang Province, China. Our results indicate a relatively low incidence of severe adverse reactions. Nevertheless, clinicians must administer appropriate snake antivenom and maintain vigilance during antivenom administration and post-treatment follow-up.</p><p><strong>Conclusions: </strong>Antivenom therapy was efficacious in treating <i>Deinagkistrodon acutus</i> envenomation. Approximately one in every eight patients developed anaphylactic reactions or serum sickness, although anaphylactic shock was uncommon (0.6%).</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":"63 3","pages":"196-203"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed cerebrospinal fluid removal is ineffective in treating intrathecal baclofen overdose.","authors":"Nicolas Mutel, Jérémy Lecot, Fabien Lamoureux, Doria Ikhlef, Chloé Bruneau, Ariella Ganem, Dominique Vodovar, Fabienne Tamion, Marion Giry","doi":"10.1080/15563650.2025.2451641","DOIUrl":"10.1080/15563650.2025.2451641","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"221-222"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of two-bag and three-bag acetylcysteine regimens in the treatment of paracetamol poisoning: a systematic review and meta-analysis.","authors":"Larissa Nakatsu, Josh R Lopez, Christian Mateo Garcia, Mathew Cherian, Jacob Nash, Davood Tofighi, Steven A Seifert, Susan Smolinske, Brandon J Warrick","doi":"10.1080/15563650.2025.2456116","DOIUrl":"10.1080/15563650.2025.2456116","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Worldwide, paracetamol poisoning is a common cause of acute liver failure and referral to transplant centers. Acetylcysteine has long been the mainstay of treatment, but recent literature suggests that a simplification of the \"three-bag\" method may decrease adverse effects. Our primary hypothesis is that a simplified dosing regimen (two-bag regimen) is non-inferior to the three-bag method in preventing liver injury. Our secondary hypothesis is that a simplified regimen will have lower rates of adverse effects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched Medline/PubMed, Google, Google Scholar, Cochrane Library, Embase and Toxnet on May 23, 2022. The Medical Subject Headings terms were NAC, acetaminophen toxicity, acetyl-cysteine, N-acetylcysteine, paracetamol, APAP, 2-bag, and 3-bag. The Embase terms were acetylcysteine, NAC, 2-bag, two bag, 3-bag, three bag, simplified dosing, acetaminophen, Tylenol&lt;sup&gt;®&lt;/sup&gt;, paracetamol, APAP, drug overdose, poisoning, and overdose. Studies included both non-United States Food and Drug Administration-approved and United States Food and Drug Administration-approved acetylcysteine regimens. Case reports, review articles, and animal studies were excluded. Two authors independently reviewed each study using Rayyan QCRI to determine if the studies met search criteria while blinded to the selections of each other. The two authors discussed until reaching a consensus. We used a primary outcome of non-inferiority of hepatotoxicity. We used secondary outcomes of non-allergic anaphylactoid reactions and adverse events. We conducted a fixed-effect meta-analysis using R package meta. To visually summarize the meta-analysis results, we also produced forest plots. We used Cochran's Q test and &lt;i&gt;I&lt;sup&gt;2&lt;/sup&gt;&lt;/i&gt; statistical analysis to assess heterogeneity between the studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Our search resulted in 657 total citations, which were reduced to unique citations. Of the 643 studies, 46 met the criteria for full text review, and eight met the study criteria. Of the eight studies investigating a simplified acetylcysteine regimen, four studies utilized some form of a modified two-bag infusion regimen, varying in duration or dosing of infusions, and four studies shared the same \"common\" two-bag treatment, a regimen that delivers acetylcysteine 200 mg/kg over 4 h, followed by 100 mg/kg acetylcysteine over 16 h. The six studies comparing a two-bag dosing regimen to the three-bag technique were utilized for our random effect model meta-analysis. We found no significant heterogeneity amongst the six studies for either hepatotoxicity (&lt;i&gt;Q&lt;/i&gt;(5) = 1.11; &lt;i&gt;P&lt;/i&gt; = 0.95; &lt;i&gt;I&lt;sup&gt;2&lt;/sup&gt;&lt;/i&gt; = 0%; 95% CI: 0%-74.6%) or non-allergic anaphylactoid reactions and adverse events (&lt;i&gt;Q&lt;/i&gt;(5) = 10.15; &lt;i&gt;P&lt;/i&gt; = 0.07; &lt;i&gt;I&lt;sup&gt;2&lt;/sup&gt;&lt;/i&gt; = 50.7%; 95% CI: 0%-80.4%). Compared to the traditi","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"155-165"},"PeriodicalIF":3.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}