Prolonged use of guaifenesin causes damage
How to try to improve the therapy of acetaminophen poisoning?
Research is focused on better identifying patients in need of antidote therapy and optimizing antidote therapy to avoid side effects. In addition, treatment strategies must be found for cases that are recognized too late.
Switching to a two-phase infusion of acetylcysteine over twelve hours could be an approach to reduce the risk of anaphylactic reactions and vomiting during i. Reduce v. administration .
The search for predictors of liver damage under paracetamol is of essential importance, since the clinical and biochemical signs of organ damage can only be recognized 24 hours after an overdose - far later than the optimal time for antidote therapy . In this context, changes in the International Normalized Ratio (INR) are more useful for predicting whether a liver can recover, but less for assessing the risk of liver damage. The alanine aminotransferase (ALT) is a sensitive marker for liver damage, but a bad one for the prognosis of its course . The ALT value increases relatively slowly after 24 hours, depending on the extent of the liver damage. If the ALT value is normal, it means a good outcome for acetaminophen poisoning. Conversely, a low ALT value is not a screening factor to exclude patients who do not require antidote therapy.
A search is made for markers that indicate the risk of severe liver damage faster than ALT. Examples of new biomarker candidates are :
- miRNA-122: The miRNA is expressed in the liver. Your serum level is greatly increased in acute liver failure.
- High Mobility Group Protein B1 (HMGB1): HMGB1 is released by dead cells in the event of necrosis and acts as the body's own alarm substance.
- Argininosuccinate synthase: The enzyme catalyzes the conversion of aspartate and citrulline to argininosuccinate.
In contrast to ALT, these predictors are highly sensitive to cell damage and necrosis and allow a statement to be made about whether the patient will survive, develop acute liver damage or need a transplant. |
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