SOP Paracetamolintoxikation

Die Laienwelt glaubt, Paracetamol sei ein harmloses Schmerzmittel. Allerdings stellt die Paracetamolintoxikation die häufigste Ursache eines akuten Leberversagens in den Industriestaaten dar [1]. Dabei erfolgt die Hälfte dieser Intoxikationen akzidentell. Unabhängig von der Ursache ist jedoch ein schnelles Handeln für die Prognose unabdingbar.

Schlüsselwörter

Schmerzmittel - Vergiftung - akutes Leberversagen - Hepatotoxizität - Überdosierung

Publication History

Article published online:
13 October 2021

• Literatur

• 1 Yoon E, Babar A, Choudhary M. et al. Acetaminophen-Induced Hepatotoxicity: a Comprehensive Update. J Clin Transl Hepatol 2016; 4: 131-142
• 2 Ennis ZN, Dideriksen D, Vaegter HB. et al. Acetaminophen for Chronic Pain: A Systematic Review on Efficacy. Basic Clin Pharmacol Toxicol 2016; 118: 184-189
• 3 Bunchorntavakul C, Reddy KR. Acetaminophen-related hepatotoxicity. Clin Liver Dis 2013; 17: 587-607
• 4 Clark R, Fisher JE, Sketris IS. et al. Population prevalence of high dose paracetamol in dispensed paracetamol/opioid prescription combinations: an observational study. BMC Clin Pharmacol 2012; 12: 11
• 5 Herndon CM, Dankenbring DM. Patient perception and knowledge of acetaminophen in a large family medicine service. J Pain Palliat Care Pharmacother 2014; 28: 109-116
• 6 Bernal W, Auzinger G, Dhawan A. et al. Acute liver failure. Lancet 2010; 376: 190-201
• 7 Martinez-De la Torre A, Weiler S, Bräm DS. et al. National Poison Center Calls Before vs After Availability of High-Dose Acetaminophen (Paracetamol) Tablets in Switzerland. JAMA Netw Open 2020; 3: e2022897
• 8 Piotrowska N, Klukowska-Rötzler J, Lehmann B. et al. Presentations Related to Acute Paracetamol Intoxication in an Urban Emergency Department in Switzerland. Emerg Med Int 2019; 2019: 3130843
• 9 Hodgman MJ, Garrard AR. A review of acetaminophen poisoning. Crit Care Clin 2012; 28: 499-516
• 10 Larson AM. Acetaminophen hepatotoxicity. Clin Liver Dis 2007; 11: 525-548
• 11 Faber K, Reichert C, Rauber-Lüthy C. Merkblatt Akute Paracetamolvergiftung, Tox Info Suisse 08-2020. https://www.toxinfo.ch/customer/files/32/MB-Paracetamol_202010_d.pdf
• 12 Lancaster EM, Hiatt JR, Zarrinpar A. Acetaminophen hepatotoxicity: an updated review. Arch Toxicol 2015; 89: 193-199
• 13 Wallace CI, Dargan PI, Jones AL. Paracetamol overdose: an evidence based flowchart to guide management. Emerg Med J 2002; 19: 202-205
• 14 Michna E, Duh MS, Korves C. et al. Removal of opioid/acetaminophen combination prescription pain medications: assessing the evidence for hepatotoxicity and consequences of removal of these medications. Pain Med 2010; 11: 369-378
• 15 Faber K, Reichert C, Rauber-Lüthy C. Merkblatt Paracetamolvergiftung: Wiederholte Einnahme, Tox Info Suisse 05-2013. https://www.toxinfo.ch/customer/files/721/MBParacetamol_wiederholt_2013_05_03_d_neues-Logo47.pdf
• 16 Yarema M, Chopra P, Sivilotti MLA. et al. Anaphylactoid Reactions to Intravenous N-Acetylcysteine during Treatment for Acetaminophen Poisoning. J Med Toxicol 2018; 14: 120-127
• 17 Smilkstein MJ, Knapp GL, Kulig KW. et al. Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose. Analysis of the national multicenter study (1976 to 1985). N Engl J Med 1988; 319: 1557-1562
• 18 Kanter MZ. Comparison of oral and i.v. acetylcysteine in the treatment of acetaminophen poisoning. Am J Health Syst Pharm 2006; 63: 1821-1827
• 19 Beuhler MC, Curry SC. False positive acetaminophen levels associated with hyperbilirubinemia. Clin Toxicol (Phila) 2005; 43: 167-170
• 20 Schmidt LE, Knudsen TT, Dalhoff K. et al. Effect of acetylcysteine on prothrombin index in paracetamol poisoning without hepatocellular injury. Lancet 2002; 360: 1151-1152
• 21 Thorsen S, Teisner A, Jensen SA. et al. Effect of N-acetylcysteine on the accuracy of the prothrombin time assay of plasma coagulation factor II+VII+X activity in subjects infused with the drug. Influence of time and temperature. Scand J Clin Lab Invest 2009; 69: 643-650
• 22 Dart RC, Rumack BH. Patient-tailored acetylcysteine administration. Ann Emerg Med 2007; 50: 280-281
• 23 Kociancic T, Reed MD. Acetaminophen intoxication and length of treatment: how long is long enough?. Pharmacotherapy 2003; 23: 1052-1059