From the Research
Monitoring Liver Function Tests (LFT) in Paracetamol Toxicity
- The frequency of monitoring LFT in cases of paracetamol toxicity is crucial for early detection of hepatotoxicity 1.
- Studies suggest that serial blood tests can be performed if patients present prior to 8 hours post-overdose for ultimate specificity, or a single blood test can be taken if presenting more than 8 hours post-overdose 1.
- Patients receiving acetylcysteine within 8 hours of their overdose, with a product less than 10,000 mg/L × IU/L have a low likelihood of developing hepatotoxicity, and may require less frequent monitoring 1.
- In cases where patients present with an initial undetectable paracetamol level and normal liver enzymes, LFTs should still be monitored closely, as moderate liver enzyme elevation can occur despite normal initial liver enzymes 2.
- The paracetamol-aminotransferase multiplication product can be used to define liver injury risk, and patients with a product less than 1500 mg/L × IU/L may be suitable for an abbreviated acetylcysteine regimen and less frequent monitoring 1.
Key Factors Influencing Monitoring Frequency
- Time from ingestion to presentation: patients presenting within 8 hours of overdose may require more frequent monitoring 1, 3.
- Serum paracetamol concentration: patients with higher serum paracetamol concentrations may require more frequent monitoring 1, 4.
- Acetylcysteine treatment: patients receiving acetylcysteine within 8 hours of overdose may require less frequent monitoring 1, 3.
- Clinical presentation: patients with symptoms such as nausea, abdominal pain, and elevated liver enzymes may require more frequent monitoring 2.