{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T16:10:47Z","timestamp":1781626247854,"version":"3.54.5"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,27]],"date-time":"2025-12-27T00:00:00Z","timestamp":1766793600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T00:00:00Z","timestamp":1767830400000},"content-version":"vor","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pharmacol Toxicol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Rumack-Matthew nomogram has been utilized to predict hepatotoxicity from acute paracetamol poisoning. Where paracetamol concentrations are unavailable, the commencement and cessation of treatment rely on reported dose. This study aimed to investigate risk factors predicting detection of paracetamol after 15\u00a0h.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis was conducted at two emergency centers from 2010 to 2020. Patients aged\u2009\u2265\u200914 years who ingested\u2009\u2265\u200975\u00a0mg\/kg within 15\u00a0h were included. Exclusion criteria were chronic liver disease, taking multiple doses, sustained-release formations, or activated charcoal administration. Multinomial logistic regression was used to assess risk factors for detection of paracetamol after 15\u00a0h, and the area under the curve was calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among one hundred and ninety-four patients, 30 patients (15.4%) had detectable paracetamol and 7 patients (3.6%) showed toxic concentration after 15\u00a0h, and median ingested dose was 152.8\u00a0mg\/kg. Time to presentation was significant for toxic concentration (Odds ratio\u2009=\u20091908), the area under the curve was 0.969, 612\u00a0min cut-off. Ingested dose and elevated liver enzyme were valid for detectable concentration (Odds ratio\u2009=\u20092.118 and 4.458), the area under the curve of ingested dose was 0.633, 105.2\u00a0mg\/kg cut-off.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Where paracetamol concentrations are unavailable and the United Kingdom guideline followed, for patients\u2009\u2265\u200914 years who present within 15\u00a0h and report ingestion\u2009\u2265\u200975\u00a0mg\/kg, maximum therapeutic dose, N-acetylcysteine should be initiated. Furthermore, for patients who present after 10\u00a0h, ingested\u2009&gt;\u2009105.2\u00a0mg\/kg or report elevated liver enzyme, supplementary N-acetylcysteine is strongly advised.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40360-025-01075-y","type":"journal-article","created":{"date-parts":[[2025,12,27]],"date-time":"2025-12-27T04:34:35Z","timestamp":1766810075000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of cut-off values in acute paracetamol poisoning for safe termination of N-acetylcysteine"],"prefix":"10.1186","volume":"27","author":[{"given":"Jeeyong","family":"Lim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyungman","family":"Cha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,27]]},"reference":[{"key":"1075_CR1","doi-asserted-by":"publisher","first-page":"871","DOI":"10.1542\/peds.55.6.871","volume":"55","author":"BH Rumack","year":"1975","unstructured":"Rumack BH, Matthew H. Acetaminophen poisoning and toxicity. Pediatrics. 1975;55:871\u20136.","journal-title":"Pediatrics"},{"issue":"1","key":"1075_CR2","first-page":"3","volume":"40","author":"BH Rumack","year":"2002","unstructured":"Rumack BH. Acetaminophen hepatotoxicity: the first 35 years. Clin Toxicol. 2002;40(1):3\u201320.","journal-title":"Clin Toxicol"},{"key":"1075_CR3","unstructured":"Medicines and Healthcare Products Regulatory Agency. Paracetamol overdose: Simplification of the use of intravenous acetylcysteine. https:\/\/webarchive.nationalarchives.gov.uk\/20150110162216\/http:\/\/www.mhra.gov.uk\/Safetyinformation\/Safetywarningsalertsandrecalls\/Safetywarningsandmessagesformedicines\/CON178225. Accessed 18 Sep 2020."},{"issue":"2","key":"1075_CR4","doi-asserted-by":"publisher","first-page":"91","DOI":"10.3109\/15563650.2012.659252","volume":"50","author":"BH Rumack","year":"2012","unstructured":"Rumack BH, Bateman DN. Acetaminophen and acetylcysteine dose and duration: past, present and future. Clin Toxicol (Phila). 2012;50(2):91\u20138.","journal-title":"Clin Toxicol (Phila)"},{"key":"1075_CR5","first-page":"251","volume":"72","author":"A Koppen","year":"2014","unstructured":"Koppen A, van Riel A, de Vries I, Meulenbelt J. Recommendations for the Paracetamol treatment nomogram and side effects of N-acetylcysteine. Neth J Med. 2014;72:251\u20137.","journal-title":"Neth J Med"},{"issue":"4","key":"1075_CR6","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1039\/C9TX00002J","volume":"8","author":"DN Bateman","year":"2019","unstructured":"Bateman DN, Dear JW. Acetylcysteine in Paracetamol poisoning: a perspective of 45 years of use. Toxicol Res (Camb). 2019;8(4):489\u201398.","journal-title":"Toxicol Res (Camb)"},{"key":"1075_CR7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1472-6904-12-6","volume":"12","author":"SM Senarathna","year":"2012","unstructured":"Senarathna SM, Sri Ranganathan S, Buckley N, Fernandopulle R. A cost effectiveness analysis of the preferred antidotes for acute Paracetamol poisoning patients in Sri Lanka. BMC Clin Pharmacol. 2012;12:1\u20137.","journal-title":"BMC Clin Pharmacol"},{"issue":"8","key":"1075_CR8","doi-asserted-by":"publisher","first-page":"772","DOI":"10.3109\/15563650.2013.830733","volume":"51","author":"SB Duffull","year":"2013","unstructured":"Duffull SB, Isbister GK. Predicting the requirement for N-acetylcysteine in Paracetamol poisoning from reported dose. Clin Toxicol (Phila). 2013;51(8):772\u20136.","journal-title":"Clin Toxicol (Phila)"},{"issue":"1","key":"1075_CR9","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/s40360-021-00547-1","volume":"23","author":"HH Jeong","year":"2022","unstructured":"Jeong HH, Cha K, Choi KH, So BH. Evaluation of cut-off values in acute Paracetamol overdose following the united Kingdom guidelines. BMC Pharmacol Toxicol. 2022;23(1):5\u201312.","journal-title":"BMC Pharmacol Toxicol"},{"key":"1075_CR10","unstructured":"National Health Service. UK Chief medical officers\u2019 low-risk drinking guidelines. https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/545937\/UK_CMOs__report.pdf. 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XC23RIDI0008), and the need for informed consent was waived due to the nature of the retrospective study. This clinical research methods were carried out in accordance with the ethical principles of the Declaration of Helsinki, the Good Clinical Practice in the Republic of Korea (KGCP) and relevant law of the Life Ethics and Safety Act in the Republic of Korea.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"8"}}