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6650 Predictors of nephrotoxicity following paracetamol overdose: a systematic review
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6650 Predictors of nephrotoxicity following paracetamol overdose: a systematic review
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Journal Article
6650 Predictors of nephrotoxicity following paracetamol overdose: a systematic review
2024
Overview
ObjectivesParacetamol is one of the most common drugs used in overdose.1 Current guidelines focus on early identification and management of liver toxicity. However, kidney toxicity may also occur after paracetamol overdose,2 but there is currently no guidance around how best to identify those at risk. The aim of this systematic review is to identify the evidence base for potential predictors of kidney toxicity which may be considered in the management of paracetamol overdose.MethodsA systemic search was conducted in December 2022 using Scopus, PubMed, and Web of Science. Included studies: conducted in human patients of any age and gender following paracetamol overdose, managed in a hospital setting; investigated serum phosphate, vomiting episodes, Kidney Injury Molecule-1, or urinalysis as predictors for nephrotoxicity; were available in full text English. Studies were excluded if they: included overdose of other drugs; investigated treatment with N-acetylcysteine; had an outcome of hepatotoxicity alone; were not conducted in humans; or used creatinine alone as a predictor of AKI.ResultsOf 567 articles identified, seven papers met the inclusion criteria.Abstract 6650 Table 1 Predictor Outcome Number of patients Result Type of study [Reference ] Serum phosphate Hypophosphatemia 273 Minimum serum phosphate concentration:• Patients with no treatment: 1.05mmol/l.• Patients with liver damage:0.45mmol/l Case series [3] Serum phosphate Hypophosphatemia 1 33-year-old woman. Plasma phosphate levels decreased to 0.10mmol/l on day 5. Case report [4] Vomiting episodes Serum creatinine levels increased with number of vomiting episodes. 291 Mean peak serum creatinine:• Patients with no episodes of vomiting: 66.74mmol/l.• Patients with >3 episodes of vomiting: 71.9mmol/l Observational retrospective case review [5] Kidney Injury Molecule-1 Increased KIM-1 concentration after paracetamol overdose. 74 Absolute KIM-1 concentration:• Healthy patients: 70.75pg/mg.• Patients with AKI: 16152.51pg/mg. Cohort study [6] Kidney Injury Molecule-1 Increased KIM-1 concentration after paracetamol overdose. 135 Mean KIM-1 concentration:• Patients who survived: 112.7pg/ml.• Patients who had a liver transplant and died: 1182.2pg/ml Cross-sectional cohort study [7] Urinalysis Renal impairment. 1 Protein 4+ on urinalysis of a 15-year-old girl. Case report [8] Urinalysis Renal impairment. 1 Protein 1+ on urinalysis of a 16-year-old girl, with decreased specific gravity and granular casts with erythrocytes and leukocytes on microscopic evaluation. Case report [9] ConclusionAnalysis of study results supports the monitoring of the suggested predictors in monitoring outcomes of paracetamol poisoning. Future research may include cohort studies to follow-up patients, and investigations into the pathophysiology of outcomes presented.ReferencesAgrawal S, Khazaenia B. StatPearls [Internet] Treasure Island (FL), 2023 Jan.Campbell NR, Baylis B. Postgrad Med J, 1992 Feb.Jones AF, et al. Lancet, 1989.Eckardt K, et al. Nephrology Dialysis Transplantation, 1999.Zyoud SH, et al. Basic & Clinical Pharmacology & Toxicology, 2010.Antoine DJ, et al. Hepatology, August 2015.Pavkovic M, et al. Toxicological Sciences, 2016.Ammenti A, et al. Paedaitric Nephrology, 1999.Ozkaya O. Renal Failure, 2010.
