From the Research
Liver Function Tests (LFT) Monitoring in Paracetamol Toxicity
The frequency of Liver Function Tests (LFT) monitoring in Paracetamol (Acetaminophen) toxicity is crucial for early detection of hepatotoxicity.
- Peak serum transaminase activities usually occur 48-96h after acute ingestion 1.
- Patients who have chronically ingested excessive APAP doses and develop hepatotoxicity usually present with such, and renal failure is more common in this population 1.
- A serum-aspartate-aminotransferase above 400 units/1 was always associated with severe histological liver damage 2.
- Fasting serum bile-acids were raised in 51 of the patients with abnormal liver histology; the serum-bile-acid seemed to be a more sensitive indicator of mild liver-cell damage than was the transaminase level 2.
Risk Prediction and Monitoring
Several risk prediction tools can be used to identify patients at increased risk of hepatotoxicity, including:
- Paracetamol treatment nomograms 3
- Paracetamol-aminotransferase multiplication product 3
- Prothrombin time (PT) 3
- Hepatic aminotransferase activity 3
- Psi parameter 3
- Newer biomarkers 3
- Arterial lactate value 4
Frequency of LFT Monitoring
While the exact frequency of LFT monitoring is not specified in the provided studies, it can be inferred that:
- LFTs should be monitored daily in patients with paracetamol overdose 2
- Serial blood tests can be performed if patients present prior to 8 h post-overdose for ultimate specificity, or a single blood test can be taken if presenting more than 8 h post-overdose 3
- Patients receiving acetylcysteine within 8 h of their overdose, with a product less than 10,000 mg/L × IU/L have a low likelihood of developing hepatotoxicity 3