Análise de relação entre a dose ingerida e o nível sérico de paracetamol em intoxicações agudas

Abstract

Introduction: Paracetamol is an analgesic and antipyretic widely used around the world that can cause serious liver damage when taken in excessive doses. Paracetamol intoxication is one of the main causes of acute liver failure in the United States and Europe and can lead to death or the need for a transplant. In Brazil, there is a large underreporting number of cases with heterogeneous distribution between states, but in the vast majority of cases its use in supratherapeutic doses is associated with attempts at self-extermination. This study aims to contribute to knowledge of the epidemiological and clinical profile of these patients, as well as investigating the relationship between the dose ingested and serum paracetamol levels, parameters used to determine toxicity and the need for treatment. Objective: to evaluate the existence of a relationship between the dose of ingestion reported by the patient on admission and the serum levels of paracetamol collected between 4 and 24 hours after ingestion and to carry out a descriptive epidemiological analysis. Methods: This is a cross-sectional study with prospective data collection from patients seen in person at the João XXIII Hospital Toxicology Center (CIAtox/MG) between May 2022 and December 2023. Inclusion criteria were acute paracetamol intoxication with a reported intake of at least 10g or 200mg/kg, serum paracetamol levels collected between 4 and 24 hours after intake and known weight and time of intake. When using the RumackMatthew nomogram, a cut-off point of 150mg/L was used to determine toxicity and the need for treatment. Results: At the end of the period, 41 patients were included in the study, 70.7% of whom were female, with a median age and ingested dose of 24 years (21-31) and 15g (11.4 - 16.4) respectively. All the abuse was intended as an attempt at self-extermination. The serum level was considered toxic in 51.2% of the cases and there was no relationship between this and the dose reported by the patient (p=0.636). Patients who required treatment presented later than patients whose serum level was not considered toxic (p=0.023). Discussion: The results highlight the urgent need for preventive measures and adequate psychological support and monitoring, as well as strategies to restrict access to paracetamol. The study has limitations due to the small sample size and memory and selection biases. Conclusion: The profile of the patients analyzed in this study reveals a prevalence of paracetamol intoxication in young women, who used the substance as a form of selfextermination. Given this scenario, there is a need to discuss the diagnostic tools available and their implications for patient care. Although the analysis carried out by the study did not show a positive association between the dose ingested and serum paracetamol levels, there is a clear need for more studies on the subject, which can contribute to the prevention, diagnosis and appropriate treatment of this condition.