Kennon Heard1,2, Victoria E Anderson1, Eric J Lavonas1,2,3, Richard C Dart1,2, Jody L Green1. 1. a Rocky Mountain Poison and Drug Center , Denver Health and Hospitals , Denver , CO , USA. 2. b Section of Medical Pharmacology and Toxicology, Department of Emergency Medicine , University of Colorado , Aurora , CO , USA. 3. c Department of Emergency Medicine , Denver Health and Hospitals , Denver , CO , USA.
Abstract
CONTEXT: Serum paracetamol-protein adducts (PPAs) are a novel potential biomarker of paracetamol exposure. The relationship between serum PPA concentrations and reported paracetamol use in ambulatory adults has not been previously described. MATERIALS AND METHODS: This was a cross-sectional study of ambulatory adults. A detailed medication history was obtained from all subjects and subjects were stratified by reported paracetamol use in the 2 weeks prior to enrolment. Serum PPAs were measured in all subjects and correlated with reported dose, time of last ingestion and demographics. RESULTS: We enrolled 230 in the paracetamol exposure arm and 74 in the no exposure arm. 98/230 (42.6%)of subjects who reported paracetamol exposure had PPA detected and 68/74 (91.9%) of subjects who denied paracetamol exposure had no PPA detected. PPA concentrations were positively correlated with total paracetamol dose and with more recent ingestion. DISCUSSION: Detection of serum PPA generally reflects paracetamol exposure histories in ambulatory adults. Concentrations are well correlated with reported dose and time from last dose. CONCLUSIONS: Serum PPA can be detected with reported therapeutic use of paracetamol but may not be detected in all patients who report taking paracetamol.
CONTEXT: Serum paracetamol-protein adducts (PPAs) are a novel potential biomarker of paracetamol exposure. The relationship between serum PPA concentrations and reported paracetamol use in ambulatory adults has not been previously described. MATERIALS AND METHODS: This was a cross-sectional study of ambulatory adults. A detailed medication history was obtained from all subjects and subjects were stratified by reported paracetamol use in the 2 weeks prior to enrolment. Serum PPAs were measured in all subjects and correlated with reported dose, time of last ingestion and demographics. RESULTS: We enrolled 230 in the paracetamol exposure arm and 74 in the no exposure arm. 98/230 (42.6%)of subjects who reported paracetamol exposure had PPA detected and 68/74 (91.9%) of subjects who denied paracetamol exposure had no PPA detected. PPA concentrations were positively correlated with total paracetamol dose and with more recent ingestion. DISCUSSION: Detection of serum PPA generally reflects paracetamol exposure histories in ambulatory adults. Concentrations are well correlated with reported dose and time from last dose. CONCLUSIONS: Serum PPA can be detected with reported therapeutic use of paracetamol but may not be detected in all patients who report taking paracetamol.
Entities:
Keywords:
APAP-CYS; Paracetamol; overdose; protein adducts
Authors: Sibo Jiang; Valvanera Vozmediano; Susan M Abdel-Rahman; Stephan Schmidt; Laura P James Journal: J Clin Pharmacol Date: 2019-05-17 Impact factor: 3.126
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