Deliberate self-poisoning with acetaminophen: A comparison with other medications

Novack, Victor; Jotkowitz, Alan B.; Delgado, Jorge; Shleyfer, Elena; Barski, Leonid; Porath, Avi

doi:10.1016/j.ejim.2005.06.004

« Previous Next »European Journal of Internal Medicine
Volume 16, Issue 8 , Pages 585-589, December 2005

Deliberate self-poisoning with acetaminophen: A comparison with other medications

Victor Novack
- Department of Epidemiology, Soroka University Medical Center, Faculty of the Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Internal Medicine “F”, Soroka University Medical Center, Faculty of the Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Corresponding author. Department of Internal Medicine “F”, Soroka University Medical Center, P.O. Box 151, Beer-Sheva, 84101, Israel. Tel.: +972 8 640 3431.
Alan B. Jotkowitz
- Department of Internal Medicine “F”, Soroka University Medical Center, Faculty of the Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Jorge Delgado
- Department of Gastroenterology, Soroka University Medical Center, Faculty of the Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Elena Shleyfer
- Department of Internal Medicine “F”, Soroka University Medical Center, Faculty of the Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Leonid Barski
- Department of Internal Medicine “F”, Soroka University Medical Center, Faculty of the Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Avi Porath
- Department of Internal Medicine “F”, Soroka University Medical Center, Faculty of the Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

Received 14 April 2005; received in revised form 13 May 2005; accepted 2 June 2005.

Abstract

Background

Acetaminophen is the most common drug employed in deliberate self-poisoning (DSP) in many countries and can lead to acute liver failure. The purpose of the present study was to compare DSP with acetaminophen with DSP with other medications.

Methods

From January 2001 to December 2002, all patients admitted after DSP to Soroka University Hospital in Beer-Sheva, Israel, were identified. Demographic data and medical history were obtained retrospectively.

Results

There were 282 incidences of DSP in the study period. The mean age of 94 patients with an acetaminophen overdose was lower than that of patients who had attempted DSP with other medications (24.8 vs. 34.6 years, p<0.001). There was no gender or ethnic difference between the groups. Patients with DSP with acetaminophen were less likely to make recurrent attempts (23.4% vs. 39.9% p=0.006), less likely to have psychiatric disorders (32% vs. 59% p<0.001), and had a shorter hospital stay (1.7 vs. 2.1 days, p=0.05). The acetaminophen group had less of an impairment in level of consciousness (84% vs. 52.1% p<0.001) and had less need for ICU care (6.4% vs. 14.9%, p=0.04). Serum levels were checked in 68 (72.3%) of the patients in the acetaminophen group and they were found to be high in 6 (8.8%) of them (95% CI 2.1–15.5%).

Conclusion

Taking an overdose of acetaminophen is a common method of DSP, with patients tending to have a more benign presentation and shorter hospital stay than those who attempt DSP with other medications. Further research on the optimal care of these patients and multi-disciplinary approaches to DSP prevention are needed.

Keywords: Deliberate self-poisoning, Acetaminophen, Toxicology