{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T23:05:15Z","timestamp":1790118315931,"version":"4.0.1"},"reference-count":41,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,4,6]],"date-time":"2023-04-06T00:00:00Z","timestamp":1680739200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1055176"],"award-info":[{"award-number":["1055176"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["ascpt.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Pharma and Therapeutics"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:p>\n                    Acetaminophen (APAP) is commonly taken in overdose and can cause acute liver injury via the toxic metabolite NAPQI formed by cytochrome (CYP) P450 pathway. We aimed to evaluate the concentrations of APAP metabolites on presentation following an acute APAP poisoning and whether these predicted the subsequent onset of hepatotoxicity (peak alanine aminotransferase &gt;\u20091,000\u2009U\/L). The Australian Toxicology Monitoring (ATOM) study is a prospective observational study, recruiting via two poison information centers and four toxicology units. Patients following an acute APAP ingestion presenting &lt;\u200924\u2009hours post\u2010ingestion were recruited. Initial samples were analyzed for APAP metabolites, those measured were the nontoxic glucuronide (APAP\u2010Glu) and sulfate (APAP\u2010Sul) conjugates and NAPQI (toxic metabolite) conjugates APAP\u2010cysteine (APAP\u2010Cys) and APAP\u2010mercapturate (APAP\u2010Mer). The primary outcome was hepatotoxicity. In this study, 200 patients were included, with a median ingested dose of 20\u2009g, 191 received acetylcysteine at median time of 5.8\u2009hours post\u2010ingestion. Twenty\u2010six patients developed hepatotoxicity, one had hepatotoxicity on arrival (excluded from analysis). Those who developed hepatotoxicity had significantly higher total CYP metabolite concentrations: (36.8\u2009\u03bcmol\/L interquartile range (IQR): 27.8\u201351.7 vs. 10.8\u2009\u03bcmol\/L IQR: 6.9\u201319.5) and these were a greater proportion of total metabolites (5.4%, IQR: 3.8\u20137.7) vs. 1.7%, IQR: 1.3\u20132.6,\n                    <jats:italic>P<\/jats:italic>\n                    \u00a0&lt;\u20090.001)]. Furthermore, those who developed hepatotoxicity had lower APAP\u2010Sul concentrations (49.1\u2009\u03bcmol\/L, IQR: 24.7\u201372.2 vs. 78.7\u2009\u03bcmol\/L, IQR: 53.6\u2013116.4) and lower percentage of APAP\u2010Sul (6.3%, IQR: 4.6\u201310.9 vs. 13.1%, IQR, 9.1\u201320.8,\n                    <jats:italic>P<\/jats:italic>\n                    \u00a0&lt;\u20090.001)]. This study found that those who developed hepatotoxicity had higher APAP metabolites derived from CYP pathway and lower sulfation metabolite on presentation. APAP metabolites may be utilized in the future to identify patients who could benefit from increased acetylcysteine or newer adjunct or research therapies.\n                  <\/jats:p>","DOI":"10.1002\/cpt.2888","type":"journal-article","created":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T05:05:14Z","timestamp":1678856714000},"page":"1304-1314","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Acetaminophen Metabolites on Presentation Following an Acute Acetaminophen Overdose (\n                    <scp>ATOM<\/scp>\n                    \u20107)"],"prefix":"10.1111","volume":"113","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0079-5056","authenticated-orcid":false,"given":"Angela L.","family":"Chiew","sequence":"first","affiliation":[{"name":"Department of Clinical Toxicology Prince of Wales Hospital  Randwick New South Wales Australia"},{"name":"Faculty of Medicine The University of New South Wales  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Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1176-7923","authenticated-orcid":false,"given":"Katherine Z.","family":"Isoardi","sequence":"additional","affiliation":[{"name":"Clinical Toxicology Unit Princess Alexandra Hospital  Brisbane Queensland Australia"},{"name":"Queensland Poisons Information Centre Queensland Children's Hospital  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin","family":"Page","sequence":"additional","affiliation":[{"name":"Clinical Toxicology Unit Princess Alexandra Hospital  Brisbane Queensland Australia"},{"name":"Queensland Poisons Information Centre Queensland Children's Hospital  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsty","family":"Ress","sequence":"additional","affiliation":[{"name":"NSW Health Pathology Prince of Wales Hospital  Randwick New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0083-282X","authenticated-orcid":false,"given":"Betty S.H.","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Clinical Toxicology Prince of Wales Hospital  Randwick New South Wales Australia"},{"name":"Faculty of Medicine The University of New South Wales  Sydney New South Wales Australia"},{"name":"New South Wales Poisons Information Centre Sydney Children's Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6326-4711","authenticated-orcid":false,"given":"Nicholas A.","family":"Buckley","sequence":"additional","affiliation":[{"name":"New South Wales Poisons Information Centre Sydney Children's Hospital  Sydney New South Wales Australia"},{"name":"Discipline of Biomedical Informatics and Digital Health The University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,4,6]]},"reference":[{"key":"e_1_2_11_1_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.50296"},{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/15563650.2019.1677022"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.7326\/M15-2211"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.20948"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/1742-6723.12373"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.3109\/15563650.2012.659252"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.13214"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.3109\/15563650.2016.1159309"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.1980.tb01812.x"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpt1974164676"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2006.01.033"},{"key":"e_1_2_11_12_1","first-page":"185","article-title":"Acetaminophen\u2010induced 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