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Extracorporeal treatment for acetaminophen poisoning: recommendations from the EXTRIP workgroup

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Gosselin, S, Juurlink, DN, Kielstein, JT, Ghannoum, M, Lavergne, V, Nolin, TD, Hoffman, RS, Extrip Workgroup (Lotte Christine Groth Høgberg, members) & Høgberg, LCG 2014, 'Extracorporeal treatment for acetaminophen poisoning: recommendations from the EXTRIP workgroup' Clinical toxicology (Philadelphia, Pa.), vol. 52, no. 8, pp. 856-67. https://doi.org/10.3109/15563650.2014.946994

APA

CBE

Gosselin S, Juurlink DN, Kielstein JT, Ghannoum M, Lavergne V, Nolin TD, Hoffman RS, Extrip Workgroup (Lotte Christine Groth Høgberg, members), Høgberg LCG. 2014. Extracorporeal treatment for acetaminophen poisoning: recommendations from the EXTRIP workgroup. Clinical toxicology (Philadelphia, Pa.). 52(8):856-67. https://doi.org/10.3109/15563650.2014.946994

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Author

Gosselin, S ; Juurlink, D N ; Kielstein, J T ; Ghannoum, M ; Lavergne, V ; Nolin, T D ; Hoffman, R S ; Extrip Workgroup (Lotte Christine Groth Høgberg, members) ; Høgberg, Lotte Christine Groth. / Extracorporeal treatment for acetaminophen poisoning : recommendations from the EXTRIP workgroup. In: Clinical toxicology (Philadelphia, Pa.). 2014 ; Vol. 52, No. 8. pp. 856-67.

Bibtex

@article{0f919177c75c45bfb5e209327c8ca80f,
title = "Extracorporeal treatment for acetaminophen poisoning: recommendations from the EXTRIP workgroup",
abstract = "BACKGROUND: The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments (ECTR) in poisoning and the results are presented here for acetaminophen (APAP).METHODS: After a systematic review of the literature, a subgroup selected and reviewed the articles and summarized clinical and toxicokinetic data in order to propose structured voting statements following a pre-determined format. A two-round modified Delphi method was chosen to reach a consensus on voting statements, and the RAND/UCLA Appropriateness Method was used to quantify disagreement. Following discussion, a second vote determined the final recommendations.RESULTS: Twenty-four articles (1 randomized controlled trial, 1 observational study, 2 pharmacokinetic studies, and 20 case reports or case series) were identified, yielding an overall very low quality of evidence for all recommendations. Clinical data on 135 patients and toxicokinetic data on 54 patients were analyzed. Twenty-three fatalities were reviewed. The workgroup agreed that N-acetylcysteine (NAC) is the mainstay of treatment, and that ECTR is not warranted in most cases of APAP poisoning. However, given that APAP is dialyzable, the workgroup agreed that ECTR is suggested in patients with excessively large overdoses who display features of mitochondrial dysfunction. This is reflected by early development of altered mental status and severe metabolic acidosis prior to the onset of hepatic failure. Specific recommendations for ECTR include an APAP concentration over 1000 mg/L if NAC is not administered (1D), signs of mitochondrial dysfunction and an APAP concentration over 700 mg/L (4630 mmol/L) if NAC is not administered (1D) and signs of mitochondrial dysfunction and an APAP concentration over 900 mg/L (5960 mmol/L) if NAC is administered (1D). Intermittent hemodialysis (HD) is the preferred ECTR modality in APAP poisoning (1D).CONCLUSION: APAP is amenable to extracorporeal removal. Due to the efficacy of NAC, ECTR is reserved for rare situations when the efficacy of NAC has not been definitively demonstrated.",
keywords = "Acetaminophen, Acetylcysteine, Drug Overdose, Drug-Induced Liver Injury, Humans, Observational Study as Topic, Randomized Controlled Trials as Topic, Renal Dialysis",
author = "S Gosselin and Juurlink, {D N} and Kielstein, {J T} and M Ghannoum and V Lavergne and Nolin, {T D} and Hoffman, {R S} and {Extrip Workgroup (Lotte Christine Groth H{\o}gberg, members)} and H{\o}gberg, {Lotte Christine Groth}",
year = "2014",
month = "8",
day = "19",
doi = "10.3109/15563650.2014.946994",
language = "English",
volume = "52",
pages = "856--67",
journal = "Clinical Toxicology",
issn = "1556-3650",
publisher = "Informa Healthcare",
number = "8",

}

RIS

TY - JOUR

T1 - Extracorporeal treatment for acetaminophen poisoning

T2 - recommendations from the EXTRIP workgroup

AU - Gosselin, S

AU - Juurlink, D N

AU - Kielstein, J T

AU - Ghannoum, M

AU - Lavergne, V

AU - Nolin, T D

AU - Hoffman, R S

AU - Extrip Workgroup (Lotte Christine Groth Høgberg, members)

A2 - Høgberg, Lotte Christine Groth

PY - 2014/8/19

Y1 - 2014/8/19

N2 - BACKGROUND: The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments (ECTR) in poisoning and the results are presented here for acetaminophen (APAP).METHODS: After a systematic review of the literature, a subgroup selected and reviewed the articles and summarized clinical and toxicokinetic data in order to propose structured voting statements following a pre-determined format. A two-round modified Delphi method was chosen to reach a consensus on voting statements, and the RAND/UCLA Appropriateness Method was used to quantify disagreement. Following discussion, a second vote determined the final recommendations.RESULTS: Twenty-four articles (1 randomized controlled trial, 1 observational study, 2 pharmacokinetic studies, and 20 case reports or case series) were identified, yielding an overall very low quality of evidence for all recommendations. Clinical data on 135 patients and toxicokinetic data on 54 patients were analyzed. Twenty-three fatalities were reviewed. The workgroup agreed that N-acetylcysteine (NAC) is the mainstay of treatment, and that ECTR is not warranted in most cases of APAP poisoning. However, given that APAP is dialyzable, the workgroup agreed that ECTR is suggested in patients with excessively large overdoses who display features of mitochondrial dysfunction. This is reflected by early development of altered mental status and severe metabolic acidosis prior to the onset of hepatic failure. Specific recommendations for ECTR include an APAP concentration over 1000 mg/L if NAC is not administered (1D), signs of mitochondrial dysfunction and an APAP concentration over 700 mg/L (4630 mmol/L) if NAC is not administered (1D) and signs of mitochondrial dysfunction and an APAP concentration over 900 mg/L (5960 mmol/L) if NAC is administered (1D). Intermittent hemodialysis (HD) is the preferred ECTR modality in APAP poisoning (1D).CONCLUSION: APAP is amenable to extracorporeal removal. Due to the efficacy of NAC, ECTR is reserved for rare situations when the efficacy of NAC has not been definitively demonstrated.

AB - BACKGROUND: The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments (ECTR) in poisoning and the results are presented here for acetaminophen (APAP).METHODS: After a systematic review of the literature, a subgroup selected and reviewed the articles and summarized clinical and toxicokinetic data in order to propose structured voting statements following a pre-determined format. A two-round modified Delphi method was chosen to reach a consensus on voting statements, and the RAND/UCLA Appropriateness Method was used to quantify disagreement. Following discussion, a second vote determined the final recommendations.RESULTS: Twenty-four articles (1 randomized controlled trial, 1 observational study, 2 pharmacokinetic studies, and 20 case reports or case series) were identified, yielding an overall very low quality of evidence for all recommendations. Clinical data on 135 patients and toxicokinetic data on 54 patients were analyzed. Twenty-three fatalities were reviewed. The workgroup agreed that N-acetylcysteine (NAC) is the mainstay of treatment, and that ECTR is not warranted in most cases of APAP poisoning. However, given that APAP is dialyzable, the workgroup agreed that ECTR is suggested in patients with excessively large overdoses who display features of mitochondrial dysfunction. This is reflected by early development of altered mental status and severe metabolic acidosis prior to the onset of hepatic failure. Specific recommendations for ECTR include an APAP concentration over 1000 mg/L if NAC is not administered (1D), signs of mitochondrial dysfunction and an APAP concentration over 700 mg/L (4630 mmol/L) if NAC is not administered (1D) and signs of mitochondrial dysfunction and an APAP concentration over 900 mg/L (5960 mmol/L) if NAC is administered (1D). Intermittent hemodialysis (HD) is the preferred ECTR modality in APAP poisoning (1D).CONCLUSION: APAP is amenable to extracorporeal removal. Due to the efficacy of NAC, ECTR is reserved for rare situations when the efficacy of NAC has not been definitively demonstrated.

KW - Acetaminophen

KW - Acetylcysteine

KW - Drug Overdose

KW - Drug-Induced Liver Injury

KW - Humans

KW - Observational Study as Topic

KW - Randomized Controlled Trials as Topic

KW - Renal Dialysis

U2 - 10.3109/15563650.2014.946994

DO - 10.3109/15563650.2014.946994

M3 - Journal article

VL - 52

SP - 856

EP - 867

JO - Clinical Toxicology

JF - Clinical Toxicology

SN - 1556-3650

IS - 8

ER -

ID: 44662756