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Cited by 50Drug-Induced Hepatotoxicity and ProtectionPoisoning and overdose treatmentsOpioid Use Disorder Treatment

Acute Ethanol Coingestion Confers a Lower Risk of Hepatotoxicity after Deliberate Acetaminophen Overdose

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Waring, W. Stephen, Stephen, Alexandra F., Malkowska, Aleksandra M., Robinson, Oliver D.G.·2008·Academic Emergency Medicine
DOI 10.1111/j.1553-2712.2007.00019.x
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Abstract

Objectives: Little is known about the clinical significance of acute ethanol coingestion around the time of acetaminophen (paracetamol) overdose. This study prospectively examined the effect of acute ethanol coingestion on risk of hepatotoxicity among patients admitted to hospital for N‐acetylcysteine (NAC) therapy after deliberate acetaminophen overdose. Methods: This was a prospective observational study and included sequential patients who presented within 24 hours of acute acetaminophen ingestion and required NAC therapy. Significant hepatotoxicity was defined by alanine transaminase > 1,000 U/L or the international normalized ratio > 1.3 after a standardized intravenous administration of 300 mg/kg NAC. Results: There were 362 patients, including 178 (49.2%) who coingested ethanol acutely. The prevalence of hepatotoxicity was 5.1% (95% CI = 2.6% to 9.5%) in those who ingested ethanol, compared to 15.2% (95% CI = 10.7% to 21.2%) in those who did not (p = 0.0027 by chi‐square proportional test). Acute ethanol intake conferred a lower risk of hepatotoxicity in patients who had acetaminophen concentrations above or below the “200‐line” and was independent of the interval between ingestion and assessment. Conclusions: Acute ethanol intake is associated with a lower risk of hepatotoxicity after acetaminophen overdose. This apparent protective effect cannot be explained solely by lower exposure to acetaminophen in this group, nor differences in the interval between ingestion and initiation of treatment. Further work is required to establish mechanisms by which ethanol might confer protection against hepatotoxicity, so as to identify novel strategies for reducing risk after acute acetaminophen ingestion.

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Research works printed but not linked: 2

  1. Vale JA, Proudfoot AT. Paracetamol (acetamino- phen) poisoning. Lancet. 1995; 346:547-52.
  2. Buckley N, Eddleston M. Paracetamol (acetamino- phen) poisoning. Clin Evid. 2005; 14:1738-44.

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Authors
Waring, W. S., Stephen, A. F., Malkowska, A. M., & Robinson, O. D. G.
Affiliations
Edinburgh Royal Infirmary (GB)
Corresponding author
Waring, W. Stephen
ORCID
Waring, W. Stephen
Venue
Academic Emergency Medicine
Publisher
Wiley
Published
2008-01
Volume
15
Issue
1
Pages
54-58
ISSN
  • 1069-6563 (ISSN-L)
  • 1553-2712
DOI
10.1111/j.1553-2712.2007.00019.x
OpenAlex
W2028145822
Cited by
50
References
34
Citations by year
2024: 1 · 2023: 2 · 2022: 3 · 2021: 3 · 2020: 5 · 2019: 1 · 2018: 1 · 2017: 3 · 2016: 3 · 2015: 3 · 2013: 4 · 2012: 8
FWCI
3.95
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 15 d)
Locations
  • Academic Emergency Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Drug-Induced Hepatotoxicity and Protection
  • Health Sciences › Medicine › Emergency Medicine › Poisoning and overdose treatments
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Keywords
acetaminophen overdose, hepatotoxicity, intentional drug overdose
MeSH terms
Acetaminophen, Ethanol, Female, Humans, Male, Prospective Studies, Risk Factors, Scotland, Self-Injurious Behavior, Analgesics, Non-Narcotic, Chemical and Drug Induced Liver Injury, Drug Overdose

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