Overdose with modified-release paracetamol (Panadol Osteo(R)) presenting to a metropolitan emergency medicine network: a case series

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Abstract

BACKGROUND: There are currently no large cases series documenting poisoning with paracetamol modified-release (Panadol Osteo(R), GlaxoSmithKline, Sydney, NSW, Australia). Management guidelines recommend at least two serum paracetamol concentrations 4 h apart and initiating treatment with N-acetylcysteine (NAC) if more than 10 g is ingested. OBJECTIVE: To describe a cohort of Panadol Osteo(R) poisoning and determine if the management of identified cases was consistent with existing guidelines. METHOD: Descriptive retrospective case series presenting to a metropolitan hospital network with paracetamol poisoning from October 2009 to September 2013. RESULTS: There were 42 cases of Panadol Osteo(R) poisoning identified. Twenty-nine patients (median ingested dose 19 950 mg) were treated with NAC, of which 27 were acute single ingestions. Of NAC-treated patients, 85 (23/27) had an initial serum paracetamol concentration that was above the nomogram line. However, 15 (4/27) had an initial non-toxic concentration that later increased above the line. In 14 untreated patients (median ingested dose 7980 mg), one was an unrecognised late line-crosser with initial non-toxic serum paracetamol concentration. Only 43 (6/14) had a repeat paracetamol concentration measured. Three patients had a 4 h paracetamol >500 mumol/L. Late line-crossing was seen in the NAC-treated group at this level. In two untreated patients, NAC should have been commenced on the reported dose. CONCLUSION: Most patients presenting with Panadol Osteo(R) poisoning requiring NAC treatment had an initial serum paracetamol concentration indicating need for treatment. A small number of late treatment nomogram line-crossers was seen on repeat paracetamol estimation. The current guideline for Panadol Osteo(R) poisoning would have detected all cases requiring NAC treatment.
Original languageEnglish
Pages (from-to)398 - 402
Number of pages5
JournalEmergency Medicine Australasia
Volume26
Issue number4
DOIs
Publication statusPublished - 2014

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