{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T16:02:29Z","timestamp":1786982549240,"version":"build-2736575974"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T00:00:00Z","timestamp":1753920000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T00:00:00Z","timestamp":1753920000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J. Med. Toxicol."],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Fomepizole has been suggested as adjunctive therapy for severe acetaminophen poisoning though clinical efficacy is unknown. We sought to determine trends in the use of fomepizole for acetaminophen poisoning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a cross-sectional analysis of hospitalized patients with acetaminophen poisoning from January 2013 through December 2024, using Epic Cosmos, a research database of 298\u00a0million patients nationally. We identified encounters involving acetaminophen poisoning by International Classification of Diseases, version 10 (ICD-10-CM) code. Data extracted included administration of N-acetylcysteine (NAC) and fomepizole, demographic data, and outcomes of death and liver transplantation. Data were analyzed using descriptive statistics to identify trends and multivariable logistic regression to determine associations with death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 114,111 hospital encounters involving acetaminophen poisoning with 64,957 (56.92%) receiving NAC, and 1,552 (1.36%) receiving fomepizole. In 2013, 0.44% of NAC-treated acetaminophen poisoning cases also received fomepizole. This rose to 6.27% in 2024. From 2013 to 2019, the proportion of NAC-treated acetaminophen cases receiving fomepizole was stable, but from 2019 to 2024, there was a 1029.64% increase in fomepizole use. Regression modeling indicated increased odds for death (OR\u2009=\u20095.88, aOR\u2009=\u20095.32 [95% CI: 4.52, 6.27]) among those who received fomepizole in addition to NAC, indicating increased fomepizole use in patients with severe toxicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Fomepizole use in acetaminophen poisoning has risen dramatically since 2019, particularly among patients at highest risk for death and liver transplantation. It is of critical importance to determine the efficacy of fomepizole for acetaminophen poisoning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s13181-025-01091-8","type":"journal-article","created":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T18:00:40Z","timestamp":1753984840000},"page":"404-408","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Trends in Fomepizole Use for Acetaminophen Poisoning in the United States; 2013\u20132024"],"prefix":"10.1007","volume":"21","author":[{"given":"Mitchell","family":"D\u2019Aloia","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dale","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randy","family":"Boley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Schamber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dillon","family":"Thorpe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trevonne M.","family":"Thompson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0945-1233","authenticated-orcid":false,"given":"Neeraj","family":"Chhabra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,31]]},"reference":[{"key":"1091_CR1","doi-asserted-by":"crossref","unstructured":"Gummin DD, Mowry JB, Beuhler MC et al. 2023 Annual Report of the National Poison Data System\u00ae (NPDS) from America\u2019s Poison Centers\u00ae: 41st Annual Report. Clin Toxicol (Phila). 2024;62(12):793\u20131027.","DOI":"10.1080\/15563650.2024.2412423"},{"issue":"24","key":"1091_CR2","doi-asserted-by":"publisher","first-page":"1557","DOI":"10.1056\/NEJM198812153192401","volume":"319","author":"MJ Smilkstein","year":"1988","unstructured":"Smilkstein MJ, Knapp GL, Kulig KW, Rumack BH. Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose. Analysis of the National multicenter study (1976 to 1985). N Engl J Med. 1988;319(24):1557\u201362.","journal-title":"N Engl J Med"},{"issue":"8","key":"1091_CR3","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1080\/15563650.2024.2377268","volume":"62","author":"MJ Moss","year":"2024","unstructured":"Moss MJ, Hinchman B, Lambson JE, et al. Assessment of high-dose acetylcysteine in acute high-risk Paracetamol (acetaminophen) ingestion. 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Am J Emerg Med. 2020;38(2):410.e5-410.e6.","journal-title":"Am J Emerg Med"},{"key":"1091_CR6","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.toxlet.2021.11.005","volume":"355","author":"AM Pourbagher-Shahri","year":"2022","unstructured":"Pourbagher-Shahri AM, Schimmel J, Shirazi FM, Nakhaee S, Mehrpour O. Use of fomepizole (4-methylpyrazole) for acetaminophen poisoning: A scoping review. Toxicol Lett. 2022;355:47\u201361.","journal-title":"Toxicol Lett"},{"key":"1091_CR7","doi-asserted-by":"crossref","unstructured":"Woolum JA, Hays WB, Patel KH. Use of fomepizole, n-acetylcysteine, and hemodialysis for massive acetaminophen overdose. Am J Emerg Med. 2020;38(3):692.e5-692.e7.","DOI":"10.1016\/j.ajem.2019.09.026"},{"issue":"2","key":"1091_CR8","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1007\/s00204-021-03211-z","volume":"96","author":"JY Akakpo","year":"2022","unstructured":"Akakpo JY, Ramachandran A, Curry SC, Rumack BH, Jaeschke H. Comparing N-acetylcysteine and 4-methylpyrazole as antidotes for acetaminophen overdose. Arch Toxicol. 2022;96(2):453\u201365.","journal-title":"Arch Toxicol"},{"issue":"8","key":"1091_CR9","doi-asserted-by":"publisher","first-page":"e2327739","DOI":"10.1001\/jamanetworkopen.2023.27739","volume":"6","author":"RC Dart","year":"2023","unstructured":"Dart RC, Mullins ME, Matoushek T, et al. Management of acetaminophen poisoning in the US and canada: A consensus statement. JAMA Netw Open. 2023;6(8):e2327739.","journal-title":"JAMA Netw Open"},{"key":"1091_CR10","unstructured":"Epic Cosmos [Internet]. [cited 2023 May 22];Available from: https:\/\/cosmos.epic.com\/"},{"key":"1091_CR11","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1186\/1472-6963-7-159","volume":"7","author":"RP Myers","year":"2007","unstructured":"Myers RP, Leung Y, Shaheen AAM, Li B. 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Clin Toxicol (Phila). 2022;60(9):1006\u201311.","journal-title":"Clin Toxicol Phila Pa"}],"container-title":["Journal of Medical Toxicology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13181-025-01091-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s13181-025-01091-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13181-025-01091-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T14:28:40Z","timestamp":1760020120000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s13181-025-01091-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,31]]},"references-count":16,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["1091"],"URL":"https:\/\/doi.org\/10.1007\/s13181-025-01091-8","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2025.04.25.25326441","asserted-by":"object"}]},"ISSN":["1556-9039","1937-6995"],"issn-type":[{"value":"1556-9039","type":"print"},{"value":"1937-6995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,31]]},"assertion":[{"value":"28 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 July 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 July 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 July 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All authors declare no conflict of interest. Neeraj Chhabra has received research grants from the National Institute on Drug Abuse (NIDA).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}}]}}