https://www.ncbi.nlm.nih.gov/pubmed/27846064

Heard K, Anderson V, Dart RC, Kile D, Lavonas E, Green JL. J Pediatr Gastroenterol Nutr. 2016 Nov 14.

Abstract

Acetaminophen toxicity is a common cause of pediatric liver failure. The diagnosis may be limited by the short window of detection of acetaminophen in serum. Recently acetaminophen protein adducts (APAP-CYS) have been used as a biomarker with a longer duration of detection. The objective of this study was to describe the serum concentrations of APAP-CYS in pediatric patients with and without reported therapeutic acetaminophen exposure.

METHODS:

A cross sectional study of children age 1 to <12 years presenting to a pediatric emergency department. Subjects were stratified by recent acetaminophen use and had serum APAP-CYS measured using LC/MS.

RESULTS:

100 patients were enrolled. All patients whose caregivers denied acetaminophen exposure had non-detectable APAP-CYS. 52% of subjects who were reported to have taken acetaminophen in the preceding 2 weeks had detectable serum APAP-CYS. The APAP-CYS concentrations were positively correlated with higher overall dose and more recent ingestion.

CONCLUSION:

APAP-CYS is detectable in the majority of children taking acetaminophen and not detected in the majority of children who are not exposed to acetaminophen.What Is Known/What Is New Acetaminophen protein adducts are detectable in children with liver failure due to acetaminophen.The concentration of adducts is higher in children with liver failure from acetaminophen than in children with liver failure from other causes.The concentration of adducts in children who are reported to be taking therapeutic doses of acetaminophen is not known.Understanding the expected range of adduct concentrations in children taking therapeutic doses of acetaminophen will increase the utility of adducts as a diagnostic test.