{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:51:35Z","timestamp":1791204695041,"version":"4.2.0"},"reference-count":36,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,12,27]],"date-time":"2023-12-27T00:00:00Z","timestamp":1703635200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2023,12,27]],"date-time":"2023-12-27T00:00:00Z","timestamp":1703635200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aim<\/jats:title>\n                    <jats:p>Paracetamol, a widely used medication, is known for its delayed hepatotoxicity in cases of overdose. However, the potential for intestinal toxicity resulting from very high paracetamol concentrations during absorption is not well explored. This study aims to investigate the presence of intestinal toxicity and its correlation with observations in early and late paracetamol toxicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Serial samples of 30 patients with acute paracetamol overdose (&gt;\u00a010\u00a0g or 200\u00a0mg\/kg) were prospectively tested. Markers of enterocyte damage, including plasma intestinal fatty acid binding protein (IFABP) and selected gut\u2010related microRNAs (miR\u201021, miR\u2010122, miR\u2010194, and miR\u2010215), were analyzed. Sub\u2010analysis was performed on patients presenting with hyperlactatemia defined as a lactate greater than 2\u00a0mmol\/L within 12\u00a0h post ingestion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In paracetamol overdose patients, median plasma IFABP was significantly elevated compared with healthy controls (720\u00a0\u03bcg\/L [interquartile range, IQR, 533\u20131644]\n                      <jats:italic>vs<\/jats:italic>\n                      270\u00a0\u03bcg\/L [IQR 153\u2013558],\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). Four patients had early hyperlactatemia and had significantly higher median plasma IFABP compared with those without early hyperlactatemia (3028\u00a0\u03bcg\/L [IQR 1399\u20133556]\n                      <jats:italic>vs<\/jats:italic>\n                      574\u00a0\u03bcg\/L [IQR 526\u2013943],\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.007). Furthermore, two microRNAs (miR\u2010122 and miR\u2010215) were downregulated in early hyperlactatemia (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.019 and\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.006, respectively). Plasma IFABP concentrations correlated with paracetamol concentration (Spearman's\n                      <jats:italic>r<\/jats:italic>\n                      \u00a0=\u00a00.55) and lactate (\n                      <jats:italic>r<\/jats:italic>\n                      \u00a0=\u00a00.60).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Paracetamol overdose causes concentration\u2010related intestinal toxicity, and this is a possible explanation for the early hyperlactatemia syndrome. Intestinal toxicity has potential impacts on pharmacokinetics of other agents ingested and on the evolution of hepatotoxicity. Further studies are required to explore the mechanisms and prognostic implications of intestinal toxicity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgh.16450","type":"journal-article","created":{"date-parts":[[2023,12,27]],"date-time":"2023-12-27T03:40:11Z","timestamp":1703648411000},"page":"920-926","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Intestinal injury in paracetamol overdose (ATOM\u20108)"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4087-4998","authenticated-orcid":false,"given":"Varan","family":"Perananthan","sequence":"first","affiliation":[{"name":"Edith Collins Centre Royal Prince Alfred Hospital  Sydney New South Wales Australia"},{"name":"Clinical Pharmacology and Toxicology Research Group, Biomedical Informatics and Digital Health, Sydney Medical School The University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fathima","family":"Shihana","sequence":"additional","affiliation":[{"name":"Edith Collins Centre Royal Prince Alfred Hospital  Sydney New South Wales Australia"},{"name":"Clinical Pharmacology and Toxicology Research Group, Biomedical Informatics and Digital Health, Sydney Medical School The University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0079-5056","authenticated-orcid":false,"given":"Angela L","family":"Chiew","sequence":"additional","affiliation":[{"name":"Clinical Pharmacology and Toxicology Research Group, Biomedical Informatics and Digital Health, Sydney Medical School The University of Sydney  Sydney New South Wales Australia"},{"name":"Emergency Department and Clinical Toxicology Prince of Wales Hospital and Community Health Services  Sydney New South Wales Australia"},{"name":"NSW Poisons Information 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