Asia Pacific Association of Medical Toxicology (APAMT)- 8th Scientific Congress‎

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Research Title: 
Acetaminophen Intoxication in Malaysia: Intentional versus Unintentional Injury
Zyoud SH
Awang R
Syed Sulaiman SA
Al-Jabi SW
Research Abstract: 

Background: Acetaminophen is the most common drug employed in accidental and  suicidal poisoning in many countries, and the prevalence and characteristics of  acetaminophen-associated outcomes in hospitalized patients in Malaysia are not well  defined.

Objectives: The aim of our study was to determine the epidemiology of various types of  acetaminophen poisoning (intentional versus unintentional) and analyze their outcome  compared with their admission characteristics.

Methods: We identified 255 consecutive patients, hospitalized for acetaminophen  poisoning over a 48- month period from January 1, 2005 to December 31, 2008, in our  state hospital. Retrospective case-control analysis was carried out using the data obtained  from the medical records. Demographic data and clinical characteristics were analyzed  among those patients. Pearson chi-square test, student’s t test, and Mann-Whitney U test were used in univariate analysis to identify factors associated with various types of  acetaminophen poisoning. SPSS 15 was used for data analysis.  Results Acetaminophen accounted for approximately half of pharmaceutical agents  (255/499) of all poisoning related admissions during the period of the study. Of the total  255 patients admitted for treatment, whose mean age was 23.1±7.6 years, 83.9% were  females. Suicidal poisoning was the majority of patients (87.5%, 223 cases). The  remaining (12.5%, 32 cases) was accidentally poisoned themselves in an attempt to  relieve pain. The ratio of females to males was found to be 5.22: 1. Suicidal overdose  patients significantly associated with a history of vomiting after ingestion (P=0.04),  higher amount of acetaminophen ingested (P< 0.001), above ‘high-risk’ treatment line  (P=0.001), elevated acetaminophen concentration (P=0.006), elevated INR (P=04),  elevated serum bilirubin (P=0.03), N-acetylcysteine (NAC) administration (P=0.001),  and long hospital stay (P=0.004). 

Conclusion: The peak acetaminophen level in the intentional (suicide) group was  significantly higher; also, cases in this group had higher rates of morbidity. Identification  of the factors associated to acetaminophen poisoning should lead to prioritization of these  target patients in more intervention.