Observational studyBritish journal of clinical pharmacology2017
Outcomes from massive paracetamol overdose: a retrospective observational study.
Observational study in British journal of clinical pharmacology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
29 citing papers in PubMed, 1 synthesis or guideline pooled it, 80 citations in OpenAlex.
- Interventions for paracetamol (acetaminophen) overdose.The Cochrane database of systematic reviews · 2018Pooled it
- The Effect of 4-Methylpyrazole on Oxidative Metabolism of Acetaminophen in Human Volunteers.Journal of medical toxicology : official journal of the American College of Medical Toxicology · 2020Trial
- Could NAPQI Contribute to Paracetamol Analgesia? Redox Modulation of Kv7 Ion Channels.Pharmacology research & perspectives · 2026Review
- N-Acetylcysteine Dose and Treatment Duration in High-Risk Acetaminophen Ingestions Treated Within Eight Hours: A Retrospective Cohort Study.Journal of medical toxicology : official journal of the American College of Medical Toxicology · 2026Observational
- Evaluation of cut-off values in acute paracetamol poisoning for safe termination of N-acetylcysteine.BMC pharmacology & toxicology · 2025Article
- Protective role of coenzyme Q10 against renal and hepatic toxicity induced by acetaminophen overdose in albino rats.Open veterinary journal · 2025Article
- Article
- Overlapping Hepatic and Neurological Toxicity Following Intentional Multidrug Poisoning with Acetaminophen, Metoclopramide, and Metronidazole: A Case Report.Clinical medicine insights. Case reports · 2025Article
- Central Mechanisms of Acetaminophen Hepatotoxicity: Mitochondrial Dysfunction by Protein Adducts and Oxidant Stress.Drug metabolism and disposition: the biological fate of chemicals · 2024Review
- Celastrol Mitigates Acetaminophen-Induced Nephrotoxicity in Rats via Targeting Renal Oxidative Stress, Inflammation, Apoptosis with Enhancement in Aquaporin 1 Level.Reports of biochemistry & molecular biology · 2024Article
- Two versus Three Infusion Regimens of N-Acetylcysteine for Acetaminophen Overdose.Pediatric reports · 2024Article
- A novel approach to low-cost, rapid and simultaneous colorimetric detection of multiple analytes using 3D printed microfluidic channels.Royal Society open science · 2024Article
- LateClinical case reports · 2023Article
- Acetaminophen Metabolites on Presentation Following an Acute Acetaminophen Overdose (ATOM-7).Clinical pharmacology and therapeutics · 2023Observational
- Fomepizole should not be used more liberally in paracetamol overdose.British journal of clinical pharmacology · 2023Article
- Renoprotective Effect of Taxifolin in Paracetamol-Induced Nephrotoxicity: Emerging Evidence from an Animal Model.Journal of clinical medicine · 2023Article
- Successful management of delayed presentation of massive paracetamol overdose in a resource-limited setting: A case report from Nepal.Clinical case reports · 2022Article
- Acute liver failure following paracetamol overdose.Journal of the Intensive Care Society · 2022Article
- Comparing N-acetylcysteine and 4-methylpyrazole as antidotes for acetaminophen overdose.Archives of toxicology · 2022Review
- Risk Factors for Hepatotoxicity Due to Paracetamol Overdose in Adults.Medicina (Kaunas, Lithuania) · 2021Article
Corrections and comments
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Authors and funding
7 authors at 5 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
linked articleThis article is commented on by Bateman DN and Dear JW. Should we treat very large paracetamol overdose differently? Br J Clin Pharmacol 2017; 83: 1163-5. https://doi.org/10.1111/bcp.13279
aimsTreatment of paracetamol (acetaminophen) overdose with acetylcysteine is standardized, with dose determined only by patient weight. The validity of this approach for massive overdoses has been questioned. We systematically compared outcomes in massive and non-massive overdoses, to guide whether alternative treatment strategies should be considered, and whether the ratio between measured timed paracetamol concentrations (APAP
methodsThis is a retrospective observational study of all patients (n = 545) between 2005 and 2013 admitted to a tertiary care toxicology service with acute non-staggered paracetamol overdose. Massive overdoses were defined as extrapolated 4-h plasma paracetamol concentrations >250 mg l
resultsIngestions of ≥30 g paracetamol correlated with higher peak serum aminotransferase (r = 0.212, P < 0.0001) and creatinine (r = 0.138, P = 0.002) concentrations. Acute liver injury, hepatotoxicity and coagulopathy were more frequent with APAP
conclusionPatients presenting following massive paracetamol overdose are at higher risk of organ injury, even when acetylcysteine is administered early. Enhanced therapeutic strategies should be considered in those who have an APAP
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.