Evaluation of cut-off values in acute paracetamol overdose following the United Kingdom guidelines

Background The United Kingdom guideline for acute paracetamol overdose has recommended the use of ‘100-treatment line’. Emergency medical centers in some developing countries lack the resources for timely reporting of paracetamol concentrations, hence treatment depends on reported dose. This study aimed to examine whether using an reported dose is safe to predict concentration above the 100-line. Methods Data were retrieved from two emergency medical centers retrospectively, between 2010 and 2017. The inclusion criteria were single acute paracetamol overdose, presentation within 15 h, and age ≥ 14 years. Multiple linear regression was performed to determine the effect of ingested dose on paracetamol concentration. Subgroups were created based on ingested dose, rate of concentration above 100-line were investigated. Results One hundred and seventy-two patients were enrolled in the primary analysis; median dose was 133.3 mg/kg and 46 (37.8%) had concentration above 100-line in the first test. Only dose per weight was moderately correlated with the first concentration (R2 = 0.410, p < 0.001). In the ≤200 mg/kg ingestion group, 18 patients showed concentration above 100-line and 8 showed acute liver injury. The cut-off value of 150 mg/kg showed 82.6% sensitivity and 73.8% specificity to predict concentration above 100-line. Conclusion Where paracetamol concentration is not available and activated charcoal is readily used, following United Kingdom guideline, it is safe to use an ingested dose of > 150 mg/kg as the cut-off value for N-acetylcysteine treatment with risk stratification for hepatotoxicity if the patient is ≥14 years and visit the ED within 15 h after an acute paracetamol overdose.

Large paracetamol overdose -- higher dose NAC is required - CON

Paracetamol overdose is common in developed countries but less than 10% involve large ingestions exceeding 30g or 500mg/kg. High dose acetylcysteine (NAC) has been proposed in patients taking large paracetamol overdoses based on reports of hepatotoxicity despite early initiation of NAC treatment with the commonly used 300 mg/kg intravenous acetylcysteine regimen. The evidence from cohorts of patients treated with the standard NAC regimen after large paracetamol overdoses shows that it is effective in most patients. Small studies in patients whose paracetamol concentration are above the 300mg/L nomogram line show that modification of the standard NAC regimen to provide a total of 400-500 mg/kg NAC over 21-22h may reduce the risk of hepatotoxicity (peak ALT>1000 IU/L) but the impact on development of hepatic failure, liver transplantation and mortality with this approach is presently unknown. Better risk stratification of patients taking paracetamol overdose may allow higher dose NAC and adjunctive treatments such as CYP2E1 inhibition and extracorporeal removal of paracetamol to be targeted to those patients at the highest risk of hepatotoxicity after a large paracetamol overdose.

Photocatalytic degradation of paracetamol using aluminosilicate supported TiO2

The continuous growth of the pharmaceutical drug industry has escalated the problem of pharmaceutical waste disposal, and subsequent contamination of aquatic bodies. Paracetamol is one of the most prescribed and purchased drugs that has been widely detected in wastewater and surface water. The present study investigated paracetamol degradation by photocatalytic treatment in a batch system using TiO2 supported on aluminosilicate recovered from waste LED panel (ATiO2). The prepared ATiO2 catalyst was characterized for morphology, elemental composition and crystallinity using scanning electron microscope (SEM) with electron dispersive X-ray spectroscopy (EDS) and X-ray diffraction (XRD), respectively. ATiO2 was spherical in morphology with a predominance of the anatase phase of TiO2 and an average size of ∼15 nm. Subsequently, the effects of operating parameters, viz., initial paracetamol concentration (1–10 mg/L), catalyst dosage (0.5–4.0 g/L) and pH (4–10) on paracetamol degradation were investigated using central composite design (CCD). A polynomial model was developed to interpret the linear and interactive effect of operating parameters on the paracetamol degradation efficiency. About 99% degradation efficiency of paracetamol was obtained at optimum conditions (Initial paracetamol concentration ∼2.74 mg/L, ATiO2 dosage ∼2.71 g/L and pH ∼ 9.5). The mechanism of paracetamol degradation was adsorption on aluminosilicate and subsequent degradation by TiO2. ATiO2 could be effectively reused up to 3 cycles, with &lt;5% decrease in the degradation efficiency.

PHOTOCATALYTIC REDUCTION OF Cu(II) ION AND TiO2-CATALYZED PARACETAMOL PHOTODEGRADATION AS AN ALTERNATIVE METHOD IN WASTE TREATMENT

<p>Recently, the issue of heavy metals are wastes is become popular such as Cu, Co, Pb, and etc. Furthermore, the presence of Cu together with paracetamol as pharmacy waste. Photocatalytic process could be an alternative to avoid the situation. This research investigated the influence of irradiation and the initial concentration of paracetamol toward TiO₂-catalyzed photoreduction of Cu(II). The research aims to develop a photoreduction method that is catalyzed by TiO₂ in the presence of paracetamol in reducing Cu(II) and paracetamol concentration. Cu(II) photoreduction process was (II) conducted in a close reactor equipped with a UV lamp. The remaining Cu(II) in solution was analyzed using Atomic Absorption Spectrophotometry (AAS) to determine its concentration and paracetamol concentration by visible spectrophotometry method. Results showed that the use of photocatalyst TiO₂improves the photoreduction of Cu(II), 15-45 minutes irradiation also contributes the increment, over the time a tiny decrease in photoreduction effectivity occur, however. At initial paracetamol concentration, 50 to 250 mg/L lead to an increase in photodegradation of paracetamol, and large decline occur over e.i. 250 mg/L, however. The presence of paracetamol may increase the effectiveness of Cu(II) photoreduction due to the prevention of radical OH^• and electrons recombination. The most effective photoreduction of 25 mL solution of ion Cu(II) 10 mg/L is readily achieve in reaction conditions using 20 mg of TiO₂ by 45 minutes irradiation in the present of 25 mL of paracetamol 250 mg/L. By those Cu(II) ion was reduced by 98.87 % and 14.73 % of paracetamol was degraded.</p>

PHOTOCATALYTIC REDUCTION OF Cu(II) ION AND TiO2-CATALYZED PARACETAMOL PHOTODEGRADATION AS AN ALTERNATIVE METHOD IN WASTE TREATMENT

<p>Recently, the issue of heavy metals are wastes is become popular such as Cu, Co, Pb, and etc. Furthermore, the presence of Cu together with paracetamol as pharmacy waste. Photocatalytic process could be an alternative to avoid the situation. This research investigated the influence of irradiation and the initial concentration of paracetamol toward TiO₂-catalyzed photoreduction of Cu(II). The research aims to develop a photoreduction method that is catalyzed by TiO₂ in the presence of paracetamol in reducing Cu(II) and paracetamol concentration. Cu(II) photoreduction process was (II) conducted in a close reactor equipped with a UV lamp. The remaining Cu(II) in solution was analyzed using Atomic Absorption Spectrophotometry (AAS) to determine its concentration and paracetamol concentration by visible spectrophotometry method. Results showed that the use of photocatalyst TiO₂improves the photoreduction of Cu(II), 15-45 minutes irradiation also contributes the increment, over the time a tiny decrease in photoreduction effectivity occur, however. At initial paracetamol concentration, 50 to 250 mg/L lead to an increase in photodegradation of paracetamol, and large decline occur over e.i. 250 mg/L, however. The presence of paracetamol may increase the effectiveness of Cu(II) photoreduction due to the prevention of radical OH^• and electrons recombination. The most effective photoreduction of 25 mL solution of ion Cu(II) 10 mg/L is readily achieve in reaction conditions using 20 mg of TiO₂ by 45 minutes irradiation in the present of 25 mL of paracetamol 250 mg/L. By those Cu(II) ion was reduced by 98.87 % and 14.73 % of paracetamol was degraded.</p>

Electrocatalytic Study of Paracetamol at a Single-Walled Carbon Nanotube/Nickel Nanocomposite Modified Glassy Carbon Electrode

A rapid, simple, and sensitive method for the electrochemical determination of paracetamol was developed. A single-walled carbon nanotube/nickel (SWCNT/Ni) nanocomposite was prepared and immobilized on a glassy carbon electrode (GCE) surface via mechanical attachment. This paper reports the voltammetry study on the effect of paracetamol concentration, scan rate, pH, and temperature at a SWCNT/Ni-modified electrode in the determination of paracetamol. The characterization of the SWCNT/Ni/GCE was performed by cyclic voltammetry. Variable pressure scanning electron microscopy (VPSEM) and energy dispersive X-ray (EDX) spectrometer were used to examine the surface morphology and elemental profile of the modified electrode, respectively. Cyclic voltammetry showed significant enhancement in peak current for the determination of paracetamol at the SWCNT/Ni-modified electrode. A linear calibration curve was obtained for the paracetamol concentration between 0.05 and 0.50 mM. The SWCNT/Ni/GCE displayed a sensitivity of 64 mA M−1and a detection limit of 1.17 × 10−7 M in paracetamol detection. The proposed electrode can be applied for the determination of paracetamol in real pharmaceutical samples with satisfactory performance. Results indicate that electrodes modified with SWCNT and nickel nanoparticles exhibit better electrocatalytic activity towards paracetamol.

Enhanced degradation of paracetamol by UV-C supported photo-Fenton process over Fenton oxidation

For the treatment of paracetamol in water, the UV-C Fenton oxidation process and classic Fenton oxidation have been found to be the most effective. Paracetamol reduction and chemical oxygen demand (COD) removal are measured as the objective functions to be maximized. The experimental conditions of the degradation of paracetamol are optimized by the Fenton process. Influent pH 3, initial H2O2 dosage 60 mg/L, [H2O2]/[Fe2+] ratio 60 : 1 are the optimum conditions observed for 20 mg/L initial paracetamol concentration. At the optimum conditions, for 20 mg/L of initial paracetamol concentration, 82% paracetamol reduction and 68% COD removal by Fenton oxidation, and 91% paracetamol reduction and 82% COD removal by UV-C Fenton process are observed in a 120 min reaction time. By HPLC analysis, 100% removal of paracetamol is observed at the above optimum conditions for the Fenton process in 240 min and for the UV-C photo-Fenton process in 120 min. The methods are effective and they may be used in the paracetamol industry.