{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T03:06:00Z","timestamp":1771643160716,"version":"3.50.1"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:p>Acetaminophen poisoning can lead to liver toxicity, potentially resulting in death. We aimed to evaluate cases of acetaminophen poisoning and investigate the impact of early initiation of the only antidote N-AC (<jats:italic toggle=\"yes\">N<\/jats:italic>-acetyl cysteine) used and explore whether there are other factors contributing to prognosis prediction.<\/jats:p>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This study was designed as a cross-sectional, observational, retrospective study. The variables of the study were paracetamol overdose, demographic information, poisoning mechanisms, clinical, laboratory findings, and clinical progression of the cases. The cases compared in whom treatment was initiated within the first 8 hours after poisoning and those in whom it was not. \u03c7<jats:sup>2<\/jats:sup>, <jats:italic toggle=\"yes\">t<\/jats:italic> test, and logistic regression analyses were conducted at appropriate facilities.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Three hundred forty-eight cases were included in the study. N-AC treatment was initiated within the first 8 hours after poisoning in 322 cases (92.5%), and 26 cases received N-AC treatment after 8 hours after poisoning. Liver toxicity developed in 6 cases (1.7%), and indications for liver transplantation were met in 36 cases (10.3%). Among the 26 cases for which treatment was not initiated within the first 8 hours, 18 cases (69.2%) had indications for liver transplantation (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.01). It was found that N-AC within the first 8 hours reduced the risk by 43 times (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.02) and being older than 6 years, being admitted to the intensive care unit, and having alanine aminotransferase values above 1000 U\/L increased the risk significantly (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.009, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.005, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001). When a receiver operating characteristic curve was plotted for the 4th-hour blood acetaminophen level to predict liver transplantation, a value of 684.5 \u03bcg\/mL emerged with 89% sensitivity and 93% specificity (area under the curve, 0.951).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>As a result, this study demonstrates the protective effect of early-initiated N-AC therapy on liver toxicity in pediatric acetaminophen poisoning cases. It also highlights a significant impact of gastrointestinal decontamination methods.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/pec.0000000000003176","type":"journal-article","created":{"date-parts":[[2024,5,8]],"date-time":"2024-05-08T22:00:07Z","timestamp":1715205607000},"page":"e89-e93","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["The Insidious Enemy of the Liver"],"prefix":"10.1097","volume":"40","author":[{"given":"Gamze","family":"G\u00f6kalp","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tu\u011f\u00e7e","family":"Nalbant","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Y\u00fcksel","family":"B\u0131c\u0131l\u0131o\u011flu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2024,5,9]]},"reference":[{"key":"bib1-20250504","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1136\/bmj.2.5512.497","article-title":"Acute liver necrosis following overdose of paracetamol","volume":"2","year":"1966","journal-title":"Br Med J"},{"key":"bib2-20250504","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1097\/00008480-200104000-00016","article-title":"Chronic acetaminophen overdosing in children: risk assessment and management","volume":"13","year":"2001","journal-title":"Curr Opin Pediatr"},{"key":"bib3-20250504","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/S0022-3476(97)70359-7","article-title":"Outcome of acetaminophen overdose in pediatric patients and factors contributing to hepatotoxicity","volume":"130","year":"1997","journal-title":"J Pediatr"},{"key":"bib4-20250504","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1080\/15563650.2020.1834219","article-title":"2019 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 37th annual report","volume":"58","year":"2020","journal-title":"Clin Toxicol (Phila)"},{"key":"bib5-20250504","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1542\/peds.83.5.772","article-title":"Parental administration of chemical agents: a cause of apparent life-threatening events","volume":"83","year":"1989","journal-title":"Pediatrics"},{"key":"bib6-20250504","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1177\/000992280003900301","article-title":"Acetaminophen intoxication during treatment: what you don't know can hurt you","volume":"39","year":"2000","journal-title":"Clin Pediatr (Phila)"},{"key":"bib7-20250504","first-page":"175","article-title":"Acetaminophen use in children: more is not better","volume":"130","year":"1997","journal-title":"J Pediatr"},{"key":"bib8-20250504","first-page":"765","article-title":"Assessment and treatment of acetaminophen overdose","volume":"10","year":"1991","journal-title":"Clin Pharm"},{"key":"bib9-20250504","doi-asserted-by":"crossref","first-page":"290","DOI":"10.2165\/00003495-198325030-00002","article-title":"Paracetamol overdosage. 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