overdose

saedzyoud's picture

Effects of Delay In Infusion of N-Acetylcysteine on Appearance of Adverse Drug Reactions After Acetaminophen Overdose: a Retrospective Study

Journal Title, Volume, Page: 
Pharmacoepidemiology and Drug Safety. Volume 19, Issue 10, October 2010, Pages: 1064–1070
Year of Publication: 
2010
Authors: 
Sa'ed H. Zyoud
WHO Collaborating Centre for Drug Information, National Poison Centre, Universiti Sains Malaysia (USM), Penang, Malaysia
Current Affiliation: 
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Rahmat Awang
WHO Collaborating Centre for Drug Information, National Poison Centre, Universiti Sains Malaysia (USM), Penang, Malaysia
Syed Azhar Syed Sulaiman
Clinical Pharmacy Program, College of Pharmaceutical Science, Universiti Sains Malaysia (USM), Penang, Malaysia
Samah W. Al-Jabi
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Preferred Abstract (Original): 

Purpose:To investigate the relationship between different types of adverse drug reaction (ADR) and late time to N-acetylcysteine (NAC) infusion in patients presenting to the hospital with acetaminophen overdose.
Methods: This is a retrospective study of patients admitted to the hospital for acute acetaminophen overdose over a period of 5 years (1 January 2004 to 31 December 2008). The primary outcome of interest was the relationship between ADR, if any, and late time to NAC infusion. Parametric and non-parametric tests were used to test differences between groups depending on the normality of the data. SPSS 15 was used for data analysis.
Results: Of 305 patients with acetaminophen overdose, 146 (47.9%) were treated with intravenous NAC and 139 (45.6%) were included in this study. Different types of ADR were observed in 94 (67.6%) patients. Late time to NAC infusion was significantly associated with cutaneous anaphylactoid reactions when compared to patients without this type of ADR (p < 0.001). However, there were no significant differences in time to NAC infusion between patients with and without the following ADR: gastrointestinal reactions (p = 0.11), respiratory reactions (p = 0.77), central nervous reactions (p = 0.64), and cardiovascular reactions (p = 0.63(
Conclusion: Late time to NAC infusion is a risk factor for developing cutaneous anaphylactoid reactions, suggesting, rather than proving, that early NAC infusion (≤8 hours) may be protective against this type of ADR.

saedzyoud's picture

High Prevalence of Hypokalemia After Acute Acetaminophen Overdose: Impact of Psychiatric Illness

Journal Title, Volume, Page: 
Human & Experimental Toxicology. 2010 Sep;29(9):773-8
Year of Publication: 
2010
Authors: 
Zyoud SH
WHO Collaborating Centre for Drug Information, National Poison Centre, Universiti Sains Malaysia, Penang, Malaysia
Current Affiliation: 
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Awang R
WHO Collaborating Centre for Drug Information, National Poison Centre, Universiti Sains Malaysia, Penang, Malaysia
Syed Sulaiman SA
WHO Collaborating Centre for Drug Information, National Poison Centre, Universiti Sains Malaysia, Penang, Malaysia
Al-Jabi SW
WHO Collaborating Centre for Drug Information, National Poison Centre, Universiti Sains Malaysia, Penang, Malaysia
Preferred Abstract (Original): 

BACKGROUND: Hypokalemia is not an isolated disease but an associated finding in a number of different diseases. It is also a commonly neglected condition among patients with acute acetaminophen overdose.
OBJECTIVES: This study intended to determine the prevalence of hypokalemia and its clinical correlates in acute psychiatric illness among hypokalemic and normokalemic patients after acetaminophen overdose.
METHODS: This is a retrospective cohort study of hospital admissions for acute acetaminophen overdose conducted over a period of 5 years from 1 January 2004 to 31 December 2008. Demographic data and different types of psychiatric illness were compared between hypokalemic and normokalemic patients. Hypokalemia was predefined by a serum concentration <3.5 mmol/L. Statistical Package for Social Sciences (SPSS) 15 was used for data analysis.
RESULTS: Two hundred and eighty patients out of 305 admissions were studied. Hypokalemia was found in 63.6% of patients with a higher prevalence in the presence of psychiatric illness (67.7%). Hypokalemic patients were significantly associated with the presence of major depression (p = .04), adjustment disorder (p < .001), anxiety (p = .01), and suicidal attempts (p = .04(
CONCLUSION: Hypokalemia was common among patients with psychiatric illness and acute acetaminophen overdose.

saedzyoud's picture

Incidence of Adverse Drug Reactions Induced By N-Acetylcysteine In Patients With Acetaminophen Overdose

Journal Title, Volume, Page: 
Hum Exp Toxicol. 2010 Mar; 29(3):153-60. Epub 2010 Jan 13
Year of Publication: 
2010
Authors: 
Zyoud SH
WHO Collaborating Centre for Drug Information, Clinical Toxicology, National Poison Centre, Universiti Sains Malaysia (USM), Penang, Malaysia
Current Affiliation: 
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Awang R
WHO Collaborating Centre for Drug Information, Clinical Toxicology, National Poison Centre, Universiti Sains Malaysia (USM), Penang, Malaysia
Syed Sulaiman SA
WHO Collaborating Centre for Drug Information, Clinical Toxicology, National Poison Centre, Universiti Sains Malaysia (USM), Penang, Malaysia
Al-Jabi SW
WHO Collaborating Centre for Drug Information, Clinical Toxicology, National Poison Centre, Universiti Sains Malaysia (USM), Penang, Malaysia
Preferred Abstract (Original): 

Background:Intravenous N-acetylcysteine (IV-NAC) is widely recognized as the antidote of choice for acetaminophen overdose. However, its use is not without adverse drug reactions (ADR) that might affect therapeutic outcome or lead to treatment delay.
Objective:The aim of this study was to investigate the type and incidence of ADR induced by IV-NAC in patients treated for acetaminophen overdose.
Methods:This is a retrospective study of patients admitted to the hospital for acute acetaminophen overdose over a period of 4 years (1 January 2005 to 31 December 2008). The primary outcome of interest in this study was the occurrence of ADR during NAC administration. Pearson chi-square test or Fisher's exact test, student's t test, and Mann-Whitney U test were used in univariate analysis. SPSS 15 was used for data analysis.
Results: Two hundred and fifty five patients were studied. Different types of ADR were observed in 119 (46.7%) cases. Of those patients, 83 (69.7%) had been treated with IV-NAC versus 36 (30.3%) who had not (p < .001). The following ADR were significantly associated with IV-NAC administration: vomiting (p = .001), flushing (p < .001), rash (p < .001), pruritus (p < .001), chest pain (p = .001), bronchospasm (p = .03), coughing (p = .01), headache (p = .001), dizziness (p < .001), convulsion (p = .03), and hypotension (p = .001). ADR were mild in 54 (43.2%), moderate in 17 (13.6%), and severe in 12 (9.6%) patients. There were no ADR in 42 (33.6%) patients. Comparative results of the characteristics of patients who reacted to IV-NAC and nonreactors showed that patients with ADR had no significant difference in age, gender, ethnicity, amount ingested, latency time, and acetaminophen level than nonreactors.
Conclusion: ADR to IV-NAC were common among patients with acetaminophen overdose, but mostly minor and all reported adverse reactions were easily managed.

Waleed Sweileh's picture

Incidence of Adverse Drug Reactions Induced by N-Acetylcysteine in Patients with Acetaminophen Overdose

Journal Title, Volume, Page: 
Hum Exp Toxicol, 29(3):153-60
Year of Publication: 
2010
Authors: 
Sweileh WM
Faculty of Pharmacy, An-Najah National University, Nablus, Palestine
Current Affiliation: 
College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Awang R
WHO Collaborating Centre for Drug Information, Clinical Toxicology, National Poison Centre, Universiti Sains Malaysia (USM), Penang, Malaysia
Syed Sulaiman SA
WHO Collaborating Centre for Drug Information, Clinical Toxicology, National Poison Centre, Universiti Sains Malaysia (USM), Penang, Malaysia
Al-Jabi SW
Preferred Abstract (Original): 

BACKGROUND:

Intravenous N-acetylcysteine (IV-NAC) is widely recognized as the antidote of choice for acetaminophen overdose. However, its use is not without adverse drug reactions (ADR) that might affect therapeutic outcome or lead to treatment delay.

OBJECTIVE:

The aim of this study was to investigate the type and incidence of ADR induced by IV-NAC in patients treated for acetaminophen overdose.

METHODS:

This is a retrospective study of patients admitted to the hospital for acute acetaminophen overdose over a period of 4 years (1 January 2005 to 31 December 2008). The primary outcome of interest in this study was the occurrence of ADR during NAC administration. Pearson chi-square test or Fisher's exact test, student's t test, and Mann-Whitney U test were used in univariate analysis. SPSS 15 was used for data analysis.

RESULTS:

Two hundred and fifty five patients were studied. Different types of ADR were observed in 119 (46.7%) cases. Of those patients, 83 (69.7%) had been treated with IV-NAC versus 36 (30.3%) who had not (p < .001). The following ADR were significantly associated with IV-NAC administration: vomiting (p = .001), flushing (p < .001), rash (p < .001), pruritus (p < .001), chest pain (p = .001), bronchospasm (p = .03), coughing (p = .01), headache (p = .001), dizziness (p < .001), convulsion (p = .03), and hypotension (p = .001). ADR were mild in 54 (43.2%), moderate in 17 (13.6%), and severe in 12 (9.6%) patients. There were no ADR in 42 (33.6%) patients. Comparative results of the characteristics of patients who reacted to IV-NAC and nonreactors showed that patients with ADR had no significant difference in age, gender, ethnicity, amount ingested, latency time, and acetaminophen level than nonreactors.

CONCLUSION:

ADR to IV-NAC were common among patients with acetaminophen overdose, but mostly minor and all reported adverse reactions were easily managed.

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