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The investigation of blood drug levels and course of acetaminophen poisoning due to application time

Background: Analgesics are reported to be responsible for 11.3% of the poisoning events in the 20 y data obtained from the Poison Counseling Centers. In this study, we aimed to investigate the relationship between epidemiological characteristics of patients, drug levels detected in acetaminophen poisoning and course of the disease due to timely, late admission and severity of intoxication.

Method: Data of the patients admitted to emergency department of Haydarpasa Numune Training and Research Hospital between Jan 2013 and Dec 2015 were retrospectively analyzed with 142 (79 f/63 m) timely and 48 (29 f/19 m) late applicants. Liver enzymes, INR, platelets, venous blood gas and demographics of these two groups were evaluated.

Results: The average acetaminophen value was 46.8 ± 55.1 in TA and 67.4 ± 60.1 in LA (p: 0.039; p<0.05). The average aspartate aminotransferase (AST) level was 24.6 ± 22.2 in timely applicants while the average AST level was 101.7 ± 125.9 in late applicants (P: 0.00011). The average alanine aminotransferase (ALT) level was 22.6 ± 27.5 in timely applicants while it was 117.5 ± 146.8 in late applicants (P: 0.00012). There was no correlation relation among those. The mean INR value was 1.11 ± 0.26 in timely applicants while it was 1.08 ± 0.13 in late applicants (p: 0.471). Platelet level distribution was 273.6 ± 63.6 in timely applicants while it was 279.4 ± 69.9 in late applicants (p: 0.609). The venous blood gas pH value of timely applicants was 7.38 ± 0.053 whereas the venous blood gas pH value was 7.37 ± 0.0518 in late applicants (p: 0.43). There was a positive significant correlation between acetaminophen levels and blood gas pH value (p: 0.000001; r: 0.445).

Conclusion: Late admission of the patient who has been admitted to emergency services due to acetaminophen poisoning is related to higher levels of acetaminophen, higher hospitalization rates, and lower discharge rates. It is useful to apply more careful and concerned approach to the patients especially if they apply late, and it will contribute to the treatment of patients.

Author(s): Abdullah Algin, Mehmet Ozgur Erdogan