Implementation and outcome of an electronic tool for detection of paracetamol overdose in a tertiary care hospital
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RESEARCH ARTICLE
Implementation and outcome of an electronic tool for detection of paracetamol overdose in a tertiary care hospital Francisco Cabrera‑Diaz1 · Claudia Zaugg1 · Silke Lim1 · Kim Blum1 · Ali Reza Salili2 Received: 13 April 2020 / Accepted: 21 October 2020 © The Author(s) 2020
Abstract Background Paracetamol is a widely used analgesic and antipyretic drug in hospitals. The development and implementation of an electronic tool with algorithm-based alerts (e-agent) in a clinical information system could reduce the risk of overdose. Objective In this study, the performance of such an e-agent developed to detect paracetamol overdosing was analyzed. Setting Swiss tertiary care hospital. Method All patients ≥ 18 years old who had documented paracetamol administration in the used clinical information system during 2017 were retrospectively screened for an absolute and relative overdosing of paracetamol (> 4 g and > 60 mg/kg/24 h, respectively). This was compared with the patients for which the e-agent had, during the same period, prospectively made an alert for absolute or relative overdosing or for a dosing interval 4 g/day (17.4%), 39 of these (0.3% of total) were given > 5 g paracetamol. None received more than 6 g. The e-agent detected 87.2% of cases with doses > 5 g. In most cases (87.9%), the cause of the absolute overdose was a switch from intravenous to oral paracetamol, resulting in an absolute overdose the day of the change. The maximal daily dose of 60 mg/kg was exceeded in 30.1% of patients weighing 60 mg/kg/day. * Ali Reza Salili [email protected] 1
Hospital Pharmacy, Kantonsspital Aarau, 5000 Aarau, Switzerland
Department of Internal Medicine, Clinical Pharmacology, Kantonsspital Aarau, 5000 Aarau, Switzerland
2
In practice, there is limited awareness of the necessity of adjusting a paracetamol dose in the presence of factors that may result in paracetamol toxicity, as well as of the importance of correct timing when switching between drug dosage forms.
Introduction In hospital setting, Paracetamol (acetaminophen) is commonly prescribed for a wide range of acute or chronic clinical conditions [1]. According to the Summary of Products Characteristics (SmPC) of paracetamol containing drugs the recommended maximal single dose is 1000 mg or 15 mg/
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kg; the maximal daily dose is 4000 mg or 60 mg/kg/day in adults [2]. Paracetamol has a safer gastrointestinal profile and fewer drug interactions than non-steroidal anti-inflammatory drugs (NSAIDs), but in case of overdosing it is associated with increased risk of mortality as it can lead to hepatotoxicity [3]. A small amount of Paracetamol is metabolized into the livertoxic N-acetyl-p-benzoquinone imine (NAPQI), that must be detoxified by glutathione [1]. Glutathione depletion (caused by malnutrition, muscular atrophy, chronic ethanol consumption or hepatic diseases) and induction of CYP450 enzymes are associated with higher hepatic toxicity [4]. Paracetamol toxicity may occur at therapeutic doses in specific populatio
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