Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

The debate over acetaminophen and acute liver failure

21.07.2004


One expert questions the acceptability of the current level of acetaminophen-related injury and death, while another suggests that acetaminophen overdoses are misunderstood

Acetaminophen overdose causes more than 450 deaths due to acute liver failure each year in the United States and this number appears to be on the rise. In 2001, the U.S. Acute Liver Failure (ALF) Study found acetaminophen responsible for 39 percent of cases. In 2003, the number had risen to 49 percent.

William M. Lee, M.D., of the University of Texas Southwestern Medical Center in Dallas, Texas and a principal investigator of the NIH-funded U.S. Acute Liver Failure Group, suggests that the FDA should consider a more aggressive and broader approach toward regulating the pain reliever to lessen the incidence of such poisonings. Lee’s article is one of two in the July issue of Hepatology that considers acetaminophen-related injury and death in the U.S.



Hepatology, the official journal of the American Association for the Study of Liver Diseases (AASLD), published by John Wiley & Sons, Inc. is available online via Wiley InterScience at http://www.interscience.wiley.com/journal/hepatology.

A counterpoint article, by Barry H. Rumack, M.D. of Rocky Mountain Poison and Drug Center at the University of Colorado, says that therapeutic doses of the drug do not place patients at risk, even when factors such as fasting and alcohol consumption are considered. He suggests that most acetaminophen-related injuries and deaths may be due to intentional overdose.

More than 50 percent of the country’s cases of acute liver failure are related to acetaminophen, according to the ALF Study, reports Lee. While acetaminophen overdose is a fairly common way to attempt suicide, most suicidal patients receive medical care within four hours and can be protected by the acetaminophen antidote.

However, Lee reports that people who ingest large quantities of the drug over several days – usually to relieve pain and often in conjunction with other narcotics – are typically not aware of the potential harm and only seek treatment after symptoms of toxicity have appeared and their prognosis is poor. These unintentional cases constitute roughly half of all cases that develop liver failure and 30 percent of all these cases are fatal.

"We must remain skeptical of ’accidental’ or ’unintentional’ overdosages in adults," writes Rumack. He suggests that cases recorded as unintentional may have actually been suicide attempts. "It is not possible to calculate the true rate, as we do not know how many patients took overdosages and did not seek treatment nor how many misrepresented what they actually did," he says.

The U.S. Food and Drug Administration regulates acetaminophen, and in 2002, its Non-prescription Drugs Advisory Committee considered evidence on related acute liver failure. The committee recommended changing package labeling to include a prominent warning that excess quantities of the drug might lead to liver injury and requiring the display of the generic name on the front of the package to avoid accidental overdose from the use of multiple acetaminophen-containing products. However, the FDA has not yet acted on that recommendation.

When the United Kingdom began aggressively working to limit acetaminophen overdosing by limiting available quantities and requiring blister packaging, the country saw a 10 percent decline in related hospital admissions, a 19 percent reduction in related deaths and a 56 percent reduction in related liver transplants. In this country, a similar limit to package size and the use of blister packaging might prevent a significant number of overdoses, says Lee.

"Changing more than the package label would also send the message that this medicine, like most others, is not globally safe, as its marketers claim," he says. "For a pain reliever with only mild-to-moderate efficacy, it would seem prudent to move toward limiting these needless deaths."

David Greenberg | EurekAlert!
Further information:
http://www.wiley.com

More articles from Health and Medicine:

nachricht Investigators may unlock mystery of how staph cells dodge the body's immune system
22.09.2017 | Cedars-Sinai Medical Center

nachricht Monitoring the heart's mitochondria to predict cardiac arrest?
21.09.2017 | Boston Children's Hospital

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: The pyrenoid is a carbon-fixing liquid droplet

Plants and algae use the enzyme Rubisco to fix carbon dioxide, removing it from the atmosphere and converting it into biomass. Algae have figured out a way to increase the efficiency of carbon fixation. They gather most of their Rubisco into a ball-shaped microcompartment called the pyrenoid, which they flood with a high local concentration of carbon dioxide. A team of scientists at Princeton University, the Carnegie Institution for Science, Stanford University and the Max Plank Institute of Biochemistry have unravelled the mysteries of how the pyrenoid is assembled. These insights can help to engineer crops that remove more carbon dioxide from the atmosphere while producing more food.

A warming planet

Im Focus: Highly precise wiring in the Cerebral Cortex

Our brains house extremely complex neuronal circuits, whose detailed structures are still largely unknown. This is especially true for the so-called cerebral cortex of mammals, where among other things vision, thoughts or spatial orientation are being computed. Here the rules by which nerve cells are connected to each other are only partly understood. A team of scientists around Moritz Helmstaedter at the Frankfiurt Max Planck Institute for Brain Research and Helene Schmidt (Humboldt University in Berlin) have now discovered a surprisingly precise nerve cell connectivity pattern in the part of the cerebral cortex that is responsible for orienting the individual animal or human in space.

The researchers report online in Nature (Schmidt et al., 2017. Axonal synapse sorting in medial entorhinal cortex, DOI: 10.1038/nature24005) that synapses in...

Im Focus: Tiny lasers from a gallery of whispers

New technique promises tunable laser devices

Whispering gallery mode (WGM) resonators are used to make tiny micro-lasers, sensors, switches, routers and other devices. These tiny structures rely on a...

Im Focus: Ultrafast snapshots of relaxing electrons in solids

Using ultrafast flashes of laser and x-ray radiation, scientists at the Max Planck Institute of Quantum Optics (Garching, Germany) took snapshots of the briefest electron motion inside a solid material to date. The electron motion lasted only 750 billionths of the billionth of a second before it fainted, setting a new record of human capability to capture ultrafast processes inside solids!

When x-rays shine onto solid materials or large molecules, an electron is pushed away from its original place near the nucleus of the atom, leaving a hole...

Im Focus: Quantum Sensors Decipher Magnetic Ordering in a New Semiconducting Material

For the first time, physicists have successfully imaged spiral magnetic ordering in a multiferroic material. These materials are considered highly promising candidates for future data storage media. The researchers were able to prove their findings using unique quantum sensors that were developed at Basel University and that can analyze electromagnetic fields on the nanometer scale. The results – obtained by scientists from the University of Basel’s Department of Physics, the Swiss Nanoscience Institute, the University of Montpellier and several laboratories from University Paris-Saclay – were recently published in the journal Nature.

Multiferroics are materials that simultaneously react to electric and magnetic fields. These two properties are rarely found together, and their combined...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

“Lasers in Composites Symposium” in Aachen – from Science to Application

19.09.2017 | Event News

I-ESA 2018 – Call for Papers

12.09.2017 | Event News

EMBO at Basel Life, a new conference on current and emerging life science research

06.09.2017 | Event News

 
Latest News

Rainbow colors reveal cell history: Uncovering β-cell heterogeneity

22.09.2017 | Life Sciences

Penn first in world to treat patient with new radiation technology

22.09.2017 | Medical Engineering

Calculating quietness

22.09.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>