Characteristics of older and younger patients with suspected paracetamol toxicity

Authors

  • Alice Kane,

    1. Kolling institute of Medical Research, University of Sydney and Royal North Shore Hospital; Sydney Medical School, University of Sydney; Departments of Clinical Pharmacology and Aged Care & Rehabilitation, Royal North Shore Hospital, Sydney, New South Wales, Australia
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  • Sarah J Mitchell,

    1. Kolling institute of Medical Research, University of Sydney and Royal North Shore Hospital; Sydney Medical School, University of Sydney; Departments of Clinical Pharmacology and Aged Care & Rehabilitation, Royal North Shore Hospital, Sydney, New South Wales, Australia
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    • Present address: Laboratory Experimental Gerontology, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA.

  • Peter R Carroll,

    1. Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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  • Slade Matthews,

    1. Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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  • Sarah N Hilmer

    Corresponding author
    1. Kolling institute of Medical Research, University of Sydney and Royal North Shore Hospital; Sydney Medical School, University of Sydney; Departments of Clinical Pharmacology and Aged Care & Rehabilitation, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Dr Sarah N Hilmer, Department of Clinical Pharmacology and Ageing, Royal North Shore Hospital. Email: shilmer@med.usyd.edu.au

Abstract

Aim:  The aim of this study was to compare the characteristics of older and younger patients with suspected paracetamol toxicity.

Methods:  A retrospective audit of the medical records of older (≥65 years, n= 25) and younger (20–30 years, n= 50) patients with a detectable paracetamol level at a Sydney hospital.

Results:  Older patients showed a different clinical pattern of suspected paracetamol toxicity and were more likely than younger patients to have multifactorial elevation of liver function tests. Additionally, older age was more likely to be associated with chronic therapeutic paracetamol dosing (71% older, 6% younger, P < 0.001), or with accidental toxic exposure (90% older, 29% younger, P < 0.001), while younger patients were more likely to have a deliberate high-dose exposure (10% older, 71% younger, P < 0.001).

Conclusions:  The age-related differences in paracetamol exposure, paracetamol levels and liver function tests described in this population should be considered when ordering and interpreting paracetamol levels.

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