Perfil epidemiológico de pacientes intoxicados com acetaminofen (Paracetamol) com intenções suicidas
Conteúdo do artigo principal
Resumo
Objetivo: este estudo busca descrever os indivíduos avaliados por sobredose de acetaminofen entre 2019 e 2020 num centro de referência de transplante hepático na Colômbia.
Metodologia: estudo derivado da análise secundário de histórias clínicas entre o dia 1.º de janeiro de 2019 e 31 de dezembro de 2020. Os critérios de inclusão abrangem indivíduos com ingestão aguda e voluntária de dose tóxicas de acetaminofen (>4 g/dia).
Resultados: sessenta e três casos, 68% mulheres, 67% menores de 18 anos e 54% estudantes. Reportou história pessoal de doença psiquiátrica, 60% e 35% pelo menos uma tentativa de suicídio prévio. A média de dose de acetaminofen foi de 15g, 46% referiram com ingestão de outras sustâncias e 13% estava sob efeito de sustancias psicoativas. 57% tinham a intenção clara de suicidar-se, assim como 81% vomitou antes de acudir ao serviço de urgências, 22% receberam medidas de descontaminação e 10% não recebeu N - acetilcisteína. Quinze indivíduos desenvolveram lesão hepática aguda, nove com critérios de severidade.
Conclusões: a população era predominantemente jovem, a história de doença psiquiátrica foi muito prevalente e a maioria referiram um evento vital que explicasse o comportamento impulsivo de consumo. Nenhum desenvolveu critérios para transplante hepático, o qual se poderia explicar pela idade dos indivíduos, os episódios de vómito precoce, e a ausência de doença hepática crónica ou de consumo de sustancias hepatotóxicas.
Detalhes do artigo
Referências
Roberts E, Delgado V, Buckner S, Latchem S, Constanti M, Miller P, et al. Paracetamol: Not as safe as we thought? A systematic literature review of observational studies. Ann Rheum Dis. 2016; 75(3):552–9.
Ghanem CI, Pérez MJ, Manautou JE, Mottino AD. Acetaminophen from liver to brain: New insights into drug pharmacological action and toxicity. Pharmacol Res. 2016; 109:119–31.
Mitchell JR, Jollow DJ, Potter WZ, Davis DC, Gillette JR, Brodie BB. Acetaminophen-induced hepatic necrosis. I. Role of drug metabolism. J Pharmacol Exp Ther. 1973; 187(1):185–94.
Mitchell JR, Jollow DJ, Potter WZ, Gillette JR, Brodie BB. Acetaminophen-induced hepatic necrosis. IV. Protective role of glutathione. J Pharmacol Exp Ther. 1973; 187(1):211–7.
Jollow DJ, Mitchell JR, Potter WZ, Davis DC, Gillette JR, Brodie BB. Acetaminophen-induced
hepatic necrosis. II. Role of covalent binding in vivo. J Pharmacol Exp Ther. 1973; 187(1):195–202.
Tittarelli R, Pellegrini M, Scarpellini MG, Marinelli E, Bruti V, Di Luca NM, et al. Hepatotoxicity
of paracetamol and related fatalities. Eur Rev Med Pharmacol Sci. 2017; 21(1 Suppl):95–101.
Burcham PC, Harman AW. Acetaminophen toxicity results in site-specific mitochondrial damage
in isolated mouse hepatocytes. J Biol Chem. 1991; 266(8):5049–54.
Meyers LL, Beierschmitt WP, Khairallah EA, Cohen SD. Acetaminophen-induced inhibition of
hepatic mitochondrial respiration in mice. Toxicol Appl Pharmacol. 1988; 93(3):378–87.
WHO. Suicide in the world: Global health estimates. World Health Organization; 2019.
Arenas A, Gómez-Restrepo C, Rondón M. Factores asociados a la conducta suicida en
Colombia. Resultados de la Encuesta Nacional de Salud Mental 2015. Rev Colomb Psiquiat.
;45(S1):68–75.
Instituto Nacional de Salud. Datos abiertos Colombia [Internet]. SIVIGILA. 2019 [citado 17
de mayo de 2021]. Disponible en: https://www.datos.gov.co/Salud-y-Protecci-n-Social/
SIVIGILA-2019/qvnt-2igj
Subdirección de Vigilancia en Salud Pública. [Intoxication with chemical substances during
second semester of 2018-Bogotá, D. C]. Bogotá, D.C.; 2019.
Aithal GP, Watkins PB, Andrade RJ, Larrey D, Molokhia M, Takikawa H, et al. Case definition and
phenotype standardization in drug-induced liver injury. Clin Pharmacol Ther. 2011; 89(6):806–15.
Fontana RJ, Seeff LB, Andrade RJ, Björnsson E, Day CP, Serrano J, et al. Standardization of
nomenclature and causality assessment in drug-induced liver injury: Summary of a clinical
research workshop. Hepatology (Baltimore, Md.). 2010; 52:730–42.
Yu YC, Mao YM, Chen CW, Chen JJ, Chen J, Cong WM, et al. CSH guidelines for the diagnosis
and treatment of drug-induced liver injury. Hepatology international. 2017; 11:221–41.
Gummin DD, Mowry JB, Beuhler MC, Spyker DA, Brooks DE, Dibert KW, et al. 2019 Annual
Report of the American Association of Poison Control Centers’ National Poison Data System
(NPDS): 37th Annual Report. Clin Toxicol (Phila). 2020; 58(12):1360–541.
Licata A, Minissale MG, Calvaruso V, Craxì A. A focus on epidemiology of drug-induced liver
injury: Analysis of a prospective cohort. Eur Rev Med Pharmacol Sci. 2017; 21(1 Suppl):112–21.
Blieden M, Paramore LC, Shah D, Ben-Joseph R. A perspective on the epidemiology of
acetaminophen exposure and toxicity in the United States. Expert Rev Clin Pharmacol.
;7(3):341–8.
Hawton K, Ware C, Mistry H, Hewitt J, Kingsbury S, Roberts D, et al. Paracetamol self-poisoning
characteristics, prevention and harm reduction. Br J Psychiatry. 1996; 168(1):43–8.
Kingsbury S, Hawton K, Steinhardt K, James A. Do adolescents who take overdoses have specific
psychological characteristics? A comparative study with psychiatric and community controls.
J Am Acad Child Adolesc Psychiatry. 1999; 38(9):1125–31.
Myers RP, Li B, Fong A, Shaheen AA, Quan H. Hospitalizations for acetaminophen overdose: A
Canadian population-based study from 1995 to 2004. BMC Public Health. 2007; 7:143.
UK Legislation. The Medicines (Sale or Supply) (Miscellaneous Provisions) Amendment (No. 2)
Regulations 1997 [Internet]. 1997 [citado el 17 de mayo de 2021]. Disponible en: https://www.
legislation.gov.uk/uksi/1997/2045/contents/made
Morgan O, Majeed A. Restricting paracetamol in the United Kingdom to reduce poisoning: A
systematic review. J Public Health. 2005; 27(1):12–8.
Heard KJ. Acetylcysteine for acetaminophen poisoning. N Engl J Med. 2008; 359(3):285–92.
Duffull SB, Isbister GK. Predicting the requirement for N-acetylcysteine in paracetamol poisoning
from reported dose. Clin Toxicol. 2013; 51(8):772–6.
Patterson WM, Dohn HH, Bird J, Patterson GA. Evaluation of suicidal patients: The SAD PERSONS
scale. Psychosomatics. 1983; 24(4):343-5.
Katz C, Randall JR, Sareen J, Chateau D, Walld R, Leslie WD, et al. Predicting suicide with the
SAD PERSONS scale. Depress Anxiety. 2017; 34(9):809–16.
David S, Hamilton JP. Drug-induced Liver Injury. US Gastroenterol Hepatol Rev. 2010; 6:73–80.
Biolato M, Araneo C, Marrone G, Liguori A, Miele L, Ponziani FR, et al. Liver transplantation for
drug-induced acute liver failure. Eur Rev Med Pharmacol Sci. 2017; 21(1 Suppl):37–45.
Schmidt LE, Larsen FS. MELD score as a predictor of liver failure and death in patients with
acetaminophen-induced liver injury. Hepatology. 2007; 45(3):789–96.
Chefirat B, Zergui A, Rahmani C, Belmessabih MN, Rezk-Kallah H. Acute paracetamol poisonings
received at the Oran University Hospital. Toxicol Reports. 2020; 7:1172–7.
Bateman DN, Dear JW. Acetylcysteine in paracetamol poisoning: A perspective of 45 years of
use. Toxicol Res. 2019; 8(4):489–98.
Chiew AL, Gluud C, Brok J, Buckley NA. Interventions for paracetamol (acetaminophen) overdose.
Cochrane database Syst Rev. 2018; 2(2):CD003328.
Slattery JT, Nelson SD, Thummel KE. The complex interaction between ethanol and
acetaminophen. Clin Pharmacol Ther. 1996; 60(3):241–6.
Waring WS, Stephen AF, Malkowska AM, Robinson ODG. Acute ethanol coingestion confers a
lower risk of hepatotoxicity after deliberate acetaminophen overdose. Acad Emerg Med Off
J Soc Acad Emerg Med. 2008; 15(1):54–8.
Yoon E, Babar A, Choudhary M, Kutner M, Pyrsopoulos N. Acetaminophen-Induced
Hepatotoxicity: A Comprehensive Update. J Clin Transl Hepatol. 2016; 4(2):131–42.
Hodgman MJ, Garrard AR. A review of acetaminophen poisoning. Crit Care Clin. 2012; 28(4):499–
Dart RC, Erdman AR, Olson KR, Christianson G, Manoguerra AS, Chyka PA, et al. Acetaminophen
poisoning: An evidence-based consensus guideline for out-of-hospital management. Clin
Toxicol. 2006; 44(1):1–18.
Chun LJ, Tong MJ, Busuttil RW, Hiatt JR. Acetaminophen hepatotoxicity and acute liver failure.
J Clin Gastroenterol. 2009; 43(4):342–9.
Tajiri K, Shimizu Y. Practical guidelines for diagnosis and early management of drug-induced
liver injury. World J Gastroenterol. 2008; 14(44):6774–85.
van Heeringen K. Stress–diathesis model of suicidal behavior. In The neurobiological basis of
suicide. Dwivedi Y, editor. Boca Raton (FL); 2012.
