Acetaminophen Concentration Research Articles

Acetaminophen induced antioxidant and detoxification responses in a stygobitic crustacean

A variety of veterinary and human medicinal products (VHMPs) are found in groundwater, an often-neglected habitat inhabited by species with unique traits, stygobitic species. It is crucial to understand the effect of VHMPs on stygobitic species because they may respond differently to stressors than surface species. Our hypothesis is that groundwater species may be more susceptible to environmental contaminants due to less plasticity in their detoxification response and acquisition of energy because subterranean habitats are more stable and isolated from anthropogenic activities. We performed a battery of biomarkers associated with important physiological functions on the stygobitic asellid crustacean Proasellus lusitanicus, after a 14-day exposure to acetaminophen, a commonly used pharmaceutical and pollutant of groundwaters. Our results show a decrease in total glutathione levels and an increase in glutathione S-transferase activity, suggesting a successful detoxification response. This helps explaining why acetaminophen did not cause oxidative damage, as well as had no effect on cholinesterase activity nor in aerobic production of energy. This study shows the remarkable capacity of P. lusitanicus to tolerate sublethal concentrations of VHMP acetaminophen. Most ecotoxicological studies on stygobitic species focused on the lethal effects of these compounds. The present study focuses on consequences at sublethal concentrations. Future studies should assess the stress levels induced to better predict and estimate the impacts of contaminants on groundwater ecosystems.

Do Propylene Glycol, Benzyl Alcohol, and Ethanol in Concomitant Drugs Influence Clinical Outcomes Following Intravenous Acetaminophen in Critically Ill Neonates?

Propylene glycol (PG) and benzyl alcohol (BA) have been shown to inhibit the metabolizing enzyme for acetaminophen in the liver. Ethanol has unpredictable effects on acetaminophen metabolism. Critically ill neonates commonly receive drug formulations containing PG, BA, and ethanol as excipients. Until now, there have been no reports on the influence of BA, PG, and ethanol as excipients in patients undergoing concomitant acetaminophen therapy. We devised the present study to evaluate whether any significant differences in plasma acetaminophen concentrations, liver function tests, and serum creatinine exist between neonates receiving excipients containing drugs compared to those without. We included neonates that were administered intravenous acetaminophen with at least one concomitant drug containing either BA, PG, or ethanol as excipients. Plasma acetaminophen concentrations and levels of liver function were evaluated using tests. The doubling of alanine aminotransferase levels was considered to be a marker of hepatotoxicity. Elevation of serum creatinine >1.5 times higher than the baseline value was considered to be indicative of an acute kidney injury. Fifty-seven neonates were recruited in the study. No significant differences in the serum acetaminophen concentrations, liver and renal function tests, and rates of successful closure of ductus arteriosus were observed between the groups. No significant changes in the serum acetaminophen levels and the clinical outcomes were observed due to the presence of BA, PG, or ethanol in concomitant drugs as excipients. Probably, drugs containing these excipients can be safely administered, and even formulations containing these excipients with acetaminophen are likely to be safe for critically ill neonates.

Effects of Acetaminophen on Reproductive Activities in Male Golden Hamsters

Acetaminophen [Paracetamol, N-acetyl-para-aminophenol (APAP)] is a common over-the- counter analgesic agent as nonsteroidal anti-inflammatory drugs (NSAIDs). The high doses or the long-term treatment of acetaminophen via usual gavage feeding resulted in damage of testicles that presented recoverable impairment, as well as liver and kidney. The influence of acetaminophen was examined in male golden hamsters treated with acetaminophen- containing diet feeding. They were divided into 5 groups and subjected to this experiment for 4 weeks: animals housed in long photoperiod (LP) as LP control, animals housed in short photoperiod (SP) for 4 weeks as SP control (SP4), and groups of animals treated with low, middle, and high concentrations of acetaminophen (Low, Middle, High groups). Also animals housed in SP for 8 weeks were included (SP8) to contrast testicular activities, if necessary. As results, spermatozoa filled the seminiferous tubules of the testicles of animals in LP control and SP4 groups. The aspects were seen in the animals taken diets of low and middle doses of acetaminophen. The animals who fed high dose of acetaminophen showed large or small testicles. The large testicles displayed all germ cells at the steps of spermatogenesis. The small testicles presented no sperm as the animals housed in SP for 8 weeks. Thus these results indicate that acetaminophen invokes the antigonadal effects and accelerates the regressing process of the testicles in the animals compared to the animals exposed to SP.

Effects of Acetaminophen on Reproductive Activities in Male Golden Hamsters

Acetaminophen [Paracetamol, N-acetyl-para-aminophenol (APAP)] is a common over-the- counter analgesic agent as nonsteroidal anti-inflammatory drugs (NSAIDs). The high doses or the long-term treatment of acetaminophen via usual gavage feeding resulted in damage of testicles that presented recoverable impairment, as well as liver and kidney. The influence of acetaminophen was examined in male golden hamsters treated with acetaminophen- containing diet feeding. They were divided into 5 groups and subjected to this experiment for 4 weeks: animals housed in long photoperiod (LP) as LP control, animals housed in short photoperiod (SP) for 4 weeks as SP control (SP4), and groups of animals treated with low, middle, and high concentrations of acetaminophen (Low, Middle, High groups). Also animals housed in SP for 8 weeks were included (SP8) to contrast testicular activities, if necessary. As results, spermatozoa filled the seminiferous tubules of the testicles of animals in LP control and SP4 groups. The aspects were seen in the animals taken diets of low and middle doses of acetaminophen. The animals who fed high dose of acetaminophen showed large or small testicles. The large testicles displayed all germ cells at the steps of spermatogenesis. The small testicles presented no sperm as the animals housed in SP for 8 weeks. Thus these results indicate that acetaminophen invokes the antigonadal effects and accelerates the regressing process of the testicles in the animals compared to the animals exposed to SP.

Determination of Acetaminophen in the Presence of Ascorbic Acid at Poly(m-Aminobenzene Sulfonic Acid) Conducting Polymer Electrode

The electrooxidation of Acetaminophen (AC) was accomplished by CV and differential pulse voltammetry at poly(m-aminobenzene sulfonic acid) (MABSA) modified sensor. As a result of the findings, the current values were enhanced and both substances were separated at the modified sensor compared to the bare electrode. A sensitive and simple modified sensor was prepared by electrodeposition of MABSA to the glassy carbon (GC) electrode surface by CV technique. There was linearly between the oxidation current and concentration of AC from 0.0 to 100 μM in phospate buffer solution at pH 7.0. The limit of detection was 2.0 nM and the sensitivity was 0.3203 μA/μM. The determination of AC was successfully and satisfactorily carried out in real samples such as human blood serum and urine at the poly (MABSA) sensor.

A dual-ratiometric electrochemical sensor based on Cu/N-doped porous carbon derived from Cu-metal organic framework for acetaminophen determination

Ratiometric electrochemical sensors with internal correction function have received extensive attention due to their good resistance to complex factors. Herein, a dual-ratiometric electrochemical sensor was fabricated for the determination of acetaminophen (AP) based on glass carbon electrode (GCE) modified by methylene blue /Cu/N-doped porous carbon (MB/Cu/N-C) composite. The Cu/N-C derived from the calcination of Cu based metal–organic framework not only had good electrochemical performance, but also provided a redox signal as an internal reference and plenty of attachment sites for another reference molecules-MB. The electrochemical results displayed that MB/Cu/N-C/GCE had three peaks at 0.34, 0.04, and −0.29 V when AP was present, which came from the electro-oxidation of AP, Cu/N-C, and MB, respectively. Two ratiometric signals, namely, IAP/IMB and IAP/ICu/N-C, were utilized to the detection of AP. The IAP/IMB and IAP/ICu/N-C were linearly correlated with the AP concentrations in the range of 0.5 to 150.0 μM and the detection limits were determined to be 0.3 μM and 0.4 μM, respectively. Meanwhile, this sensor was utilized to determinate AP in pharmaceutical tablet samples with good recoveries, which displayed the great potential of MB/Cu/N-C/GCE in clinical applications.

Considerations in Raman Spectroscopy for Real-Time API Concentration Measurement at Tablet Press Feed Frame

Raman spectroscopy is one of the important process analytical technology tools available for implementation in the continuous manufacturing of oral solid dosages. The aim of this study was to investigate several practical considerations in generating real-time measurements using Raman spectrometer at a tablet press feed frame, including the effects of fluorescence interference, photobleaching, feed-frame rpm, and material particle size. Fluorescence, in particular, is a significant drawback of Raman spectroscopy, compared to the use of near-infrared spectroscopy. Potential material sparing strategies were also investigated, including using stationary powders for calibration and isolation of feed-frame materials. Acetaminophen was used as the main active pharmaceutical ingredient (API), and microcrystalline cellulose (MCC) and lactose were used as excipients. The fluorescent behavior of MCC at 785 nm laser wavelength was reported and discussed. Raman spectra of a blend of MCC and acetaminophen and lactose and acetaminophen were collected at the feed frame of the tablet press. A series of preprocessing steps applied to remove the fluorescence interference was found to be effective, including the use of standard normal variate, subtraction of spectra of fluorescent material, baseline correction, and smoothing. Three different PLS models were prepared for different scenarios and their performances were compared. The models were able to predict the concentration of acetaminophen with root mean squared error prediction (RMSEP) of 0.29% w/w when there was no fluorescence interference and 0.57% w/w when there was fluorescence interference in background spectra. The study demonstrated the feasibility of using Raman spectroscopy for API concentration prediction even in the case of fluorescent interference and showed that Raman measurements were robust; that is, they were not much affected by feed-frame rpm and excipient particle size.

Gentamicin in Neonates with Hemodynamically Significant Patent Ductus Arteriosus.

Gentamicin has been shown to cause vasodilation in preclinical studies. Hemodynamically significant patent ductus arteriosus (hsPDA) is a commonly observed congenital heart disorder in preterm neonates. Concomitant gentamicin theoretically shall delay the closure/result in nonclosure of ductus arteriosus (DA). Similarly, hsPDA can alter the pharmacokinetics of gentamicin and so trough gentamicin concentrations. We carried out the present study to evaluate the association between gentamicin use and closure of hsPDA (treated with acetaminophen) as well as the effect of hsPDA on trough concentrations. This study was a prospective, observational study that included 60 neonates diagnosed with hsPDA by echocardiography and 102 neonates without hsPDA. Demographic details, size of DA as per echocardiography at the end of treatment with acetaminophen, gentamicin-dosing regimen, and trough concentrations were collected. Standard definitions were adhered in classifying the gestational age, birth weights, and size of DA. The numerical values are reported in median (range). Neonates with hsPDA had significantly lower daily doses of gentamicin [4.5 (2.5-10), 7 (3.2-13) mg; P < 0.001] but longer duration of therapy [8 (3-14), 5 (3-7) days; P < 0.001] than those without hsPDA in very preterm neonates. No significant differences were observed in the trough concentrations of gentamicin between the groups. No association was observed between gentamicin use and closure of DA. However, those with successful closure of DA received gentamicin for a longer duration [6 (3-10), 4 (3-14) days; P < 0.05] that was independent of acetaminophen duration and had received higher cumulative doses of gentamicin. In conclusion, we observed a significantly longer duration of gentamicin therapy in neonates with hsPDA compared to those without hsPDA. No significant differences were observed in the rates of closure of DA with concomitant gentamicin administration and gentamicin trough concentrations.

Optimization of acetaminophen adsorption onto biodegradable waste-derived activated carbon using response surface methodology

In this study, biodegradable waste like banana peel was used as a precursor for synthesis of activated carbon by the use of acidic chemical process. The activated carbon was impregnated with iron oxide for acetaminophen removal from water. Scanning electron microscope (SEM) analysis, X-ray diffraction (XRD) analysis and Brunauer-Emmet-Teller (BET) analysis were performed to characterize the iron oxide impregnated activated carbon. The SEM results denote the presence of macropores, while from the XRD it was evident that the synthesized activated carbon contains “Maghemite” (γ-Fe2O3) and “Magnetite” (Fe3O4). Specific surface area of 268.52 m2/g, and pore volume of 54.3 cc/g was obtained from BET results. Response Surface Methodology was used to optimize the adsorption process of aqueous solutions of acetaminophen using the following parameters: adsorbent dosage (0.5–1 g/L), pH (4–6), initial concentration of Acetaminophen (50–100 ppm) and time (60–120 min). Central Composite Design was employed to conduct a set of 31 runs and ANOVA was used to determine the priority of the parameters in the adsorption process. The optimum values of the parameters for 94.7 % removal efficiency of acetaminophen are, adsorbent dosage at 0.97 g/L, pH at 3.48, initial concentration at 58.3 ppm, and time at 120.9 min. The R2 value of the regression equation was determined to be 95.06%.

Pharmacokinetics of acetaminophen after a single Oral administration of 20 or 40 mg/kg to 7-9 Day-old foals.

Acetaminophen is utilized in human infants for pain management and fever. Neonatal foals might benefit from administration of acetaminophen but effective and safe dosage regimens for neonatal foals remains to be determined. The objective was to determine the plasma pharmacokinetics of acetaminophen following oral administration of a single dose of 20 mg/kg or 40 mg/kg to neonatal foals. A secondary objective was to evaluate any changes in hematology and biochemistry profiles. Randomized study. Eight clinically healthy 7-9-day old Quarter Horse foals (3 colts and 5 fillies) received a single oral dose of acetaminophen either 20 (n = 4) or 40 (n = 4) mg/kg. Hematology and biochemistry profiles were evaluated before and 7 days after drug administration. Blood samples were collected before and 8 times after acetaminophen administration for 48 h to quantify plasma acetaminophen concentrations. Plasma pharmacokinetic parameters were estimated using non- compartmental analysis. The median peak plasma concentrations (and range) occurred at 1.5 (0.5-2) hours, and 1.0 (1-2) hours for the 20 and 40 mg/kg doses. The maximum plasma concentration (and range) was 12 (7.9-17.4) μg/mL for the 20 mg/kg dose and 14 (11-18) μg/mL for 40 mg/kg dose. The median AUC0-∞ ranged from 46 to 100 and 79 to 160 h*-μg/mL for the 20 and 40 mg/kg dose, respectively. Hematology and biochemistry profiles remained within normal limits. Plasma disposition of acetaminophen after oral administration of 20 and 40 mg/kg to neonates is comparable to adult horses. However, safety and the optimal dosage regimen of acetaminophen for treating pain and or pyrexia in neonates in this age group remains to be determined.

Pharmacokinetics of single dose administration of three increasing doses of acetaminophen per os in 1-3-month-old foals.

Acetaminophen is a common analgesic and antipyretic drug used in human medicine and might be an alternative to nonsteroidal anti-inflammatory drugs for treating pain and pyrexia in foals. The pharmacokinetics and safety of differing doses of acetaminophen have not been investigated in foals. To determine the plasma pharmacokinetics and any changes in haematology and biochemistry profiles following oral administration of single doses of acetaminophen at 10, 20, and 40 mg/kg to foals. Randomised cross-over pharmacokinetic study. Six Quarter Horse (two colts and four fillies) foals received 10, 20, and 40 mg/kg acetaminophen orally once. Haematology and biochemistry profiles were performed before and 7 days after each drug administration. Blood samples were collected over 64 h after drug administration and were used to quantify plasma acetaminophen concentrations by liquid chromatography. Pharmacokinetic parameters were determined using compartmental analysis. Median (range) acetaminophen plasma concentrations were 4.4 (1.8-5.1), 6.3 (2.6-12.6), and 14 (7.3-18)μg/ml for the 10, 20, and 40 mg/kg doses, respectively. Median acetaminophen area under the concentration versus time curve (AUC)0-∞ ranged from 25 (11-32), 41 (22-74), and 105 (82-142)h × μg/ml for the 10, 20, and 40 mg/kg doses, respectively. Dose-normalised maximal concentrations and AUC0-∞ values were similar across dose concentrations (p > 0.05). Median terminal half-life for all doses was 2.7-2.8h. Haematology and biochemistry profiles were normal except for blood urea nitrogen and alkaline phosphatase concentrations. Foals were growing throughout the study, starting at 1month and ending at 3months. Deposition of drugs changes with age. The sample size was small and only single doses were evaluated. No liver biopsies were performed. Plasma disposition of acetaminophen after a single oral dose of 10, 20, and 40 mg/kg to 1-3-month-old foals varies greatly with the dose. The analgesic and antipyretic effect in foals is unknown.

Ocular penetration of oral acetaminophen in horses.

Acetaminophen (paracetamol) is increasingly used to treat painful conditions in horses but its ocular penetration has not been studied. To determine whether orally administered acetaminophen penetrates the aqueous humour of the normal equine eye and report an aqueous humour:serum acetaminophen concentration ratio in horses. In vivo experiment. Six privately owned horses with normal ophthalmic examinations weighing 568 ± 65 kg (mean ± standard deviation) and aged 11 ± 4 years were given 20 mg/kg acetaminophen orally every 12 h for a total of six doses. Physical exam parameters were recorded prior to, during, and after the dosing period. One hour after the final dose, horses were sedated and simultaneous aqueous humour and serum samples were collected and analysed for acetaminophen concentrations and selected eicosanoids. An aqueous humour:serum acetaminophen concentration ratio was calculated. A second aqueous humour sample was taken and analysed for eicosanoid concentrations 3 months after acetaminophen dosing. Physical exam data were compared between time points using a mixed model analysis (significance p < 0.05). Acetaminophen was detected in both serum and aqueous humour of all horses and mean ± standard deviation aqueous humour:serum acetaminophen concentration ratio was 44.9 ± 15.9%. No significant changes in physical exam parameters occurred during or after dosing. Eicosanoids were not detected in aqueous humour at any sampling point. Presence of acetaminophen in the aqueous humour may not relate to clinical effect. A therapeutic level of acetaminophen has not been determined in horses, and the absence of ocular inflammation does not reflect conditions in which acetaminophen may be used. Acetaminophen readily penetrates the aqueous humour of the normal equine eye after consecutive oral dosing. Further study is required to determine whether acetaminophen is useful in the treatment of ocular pain and inflammation.

Acetaminophen pharmacokinetics in infants and children with congenital heart disease.

Acetaminophen is routinely used for perioperative analgesia in children undergoing major surgical procedures. There are few estimates of acetaminophen pharmacokinetic parameters in children with congenital heart disease, especially those with cyanotic heart disease. The current study prospectively investigated differences in acetaminophen pharmacokinetics following surgery using cardiopulmonary bypass in children with cyanotic and acyanotic congenital heart disease. Children (2-6 years, 9-23 kg) presenting for median sternotomy for Fontan palliation (cyanotic patients) or two ventricle surgical repair (acyanotic patients) were eligible for inclusion. A single intravenous dose of acetaminophen (15 mg/kg) was administered at the start of sternal closure after separation from cardiopulmonary bypass. The time-course of acetaminophen concentrations were described using non-linear mixed effects models. One and two-compartment disposition models with first-order elimination were tested. Pharmacokinetic parameter estimates were scaled using allometry and standardized to a 70 kg person. There were 208 acetaminophen concentrations assayed from 30 children, 15 with cyanotic, and 15 with acyanotic heart disease. A 2-compartment model best described acetaminophen PK. Parameter estimates (population parameter variability, PPV%; 95% confidence interval, CI) were clearance CL 15.3L.h-1.70 kg-1 (22.2%; 13.8-16.7), intercompartment clearance Q 45.4L.h-1.70 kg-1 (22.4%; 25.2-61.9), central volume of distribution V1 33.5L.70 kg-1 (23.2%; 25.9-38.8), peripheral volume of distribution V2 32.1L.70 kg-1 (21.7%; 25.9-38.8). Neither clearance nor volume parameters differed between cyanotic and acyanotic patients. Acetaminophen pharmacokinetics were characterized using a 2-compartment model with first-order elimination following cardiac bypass surgery in children. Population pharmacokinetic parameter estimates were similar to other studies in children. No differences were detected between patients with cyanotic and acyanotic heart disease.

Gold Nanoparticles Decorated with Multi-Walled Carbon Nanotubes/Graphene Oxide for Voltammetric Determination of Dopamine in the Presence of Acetaminophen

We developed an electrochemical sensor by combination of Graphene oxide (GO) and multi-walled carbon nanotubes (MWCNTs) then decorated with Au-nanoparticles (AuNPs) by an electrodeposition process for detection of dopamine (DP) in the presence of acetaminophen (AC). The electrochemical properties of MWCNT/GO- AuNPs/GCE were characterized by scanning electron microscopy (SEM) and cyclic voltammetry (CV).The results displayed that Au nanoparticles were well jointed onto MWCNT/GO nanocomposite. The electrochemical responses displayed the prepared sensor showed enhanced electrocatalytic activity for the detection of DP inthe presence of acetaminophen (AC). Under optimum conditions, the proposed sensorpresented a linear response based on the DP concentration in the range of 1.0 to 165 μM with a detection limit of 0.07 μM using the differential pulse voltammogram (DPV) method.Moreover, this proposed sensor displayed a linear range concentration of AC ranging from 3 to 200.0 μM and detection limit of 0.061 μM. Also, the prepared sensor indicated excellent sensitivity and selectivity for the DP determination in the presence of AC in real samples.

383 What Aminotransferase Values Are Clinically Important After Acetaminophen Poisoning?

Acute acetaminophen ingestion management includes plotting an acetaminophen concentration on the population-based Rumack-Matthew Nomogram. Nomogram implementation reflects an estimate of probability of hepatotoxicity (defined as aspartate or alanine aminotransferase >1,000 IU/L) based on ingestion time and acetaminophen concentration. Similarly, patients with unknown or repeated supratherapeutic acetaminophen exposure are treated with acetylcysteine to mitigate liver injury. Antidote efficacy is time sensitive, however, once hepatotoxicity is identified patients often have extended hospital courses and acetylcysteine administration.

Electrochemical response of carbon paste electrodes modified with carbon nanotubes: Effects of temperature of nitrogen doping and oxygen functionalization

Carbon paste electrodes (CPE) were modified with nitrogen-doped carbon nanotubes (N-CNTs) synthesized at 750 °C (N-CNT750) and 850 °C (N-CNT850), carboxyl functionalized carbon nanotubes (MWCNTCOOH), and pristine carbon nanotubes (MWCNT). Their electrochemical properties were investigated and compared towards a common redox probe, potassium ferricyanide (K3[Fe(CN)6]). The electrochemical responses were probed using cyclic voltammetry, and the results unveiled that modification with carbon nanotubes enhanced anodic peak currents (Ipa) for the electrodes CPE/MWCNTCOOH, CPE/N-CNT750 and CPE/N-CNT850 (Ipa, p < 0.05 in relation to pure CPE). In particular, CPE modified with N-CNTs synthesized at 850 °C (CPE/N-CNT850) exhibited better electrochemical response, with lower peak-to-peak potential separation (ΔEp, p < 0.05 in relation to pure CPE). Complementary studies were conducted to investigate the electroactive area (A) and heterogeneous electron-transfer kinetics (k0). CPE/N-CNT850 (0.034 ± 0.005 cm2) and CPE/MWCNTCOOH (0.057 ± 0.002 cm2) presented more satisfactory results for the anodic and cathodic electroactive area (A), respectively. Kinetic studies revealed a higher k0 (1.03 × 10−3 cm.s−1) for the CPE/N-CNT850 electrode. Differential pulse voltammetry was employed for the electrochemical detection of Acetaminophen (AC). The response was linear for an AC concentration range from 66.2 to 259.7 μmol L−1, with the lowest detection limit (LOD) of 0.37 μmol L−1 and the highest sensitivity of 0.244 ± 0.002 μA L μmol−1 for the respective electrodes CPE/N-CNT850 and CPE/MWCNTCOOH. The CPE/N-CNT850 and CPE/MWCNTCOOH electrodes show the best correlation of results, the presence of polar groups on the surface of MWCNTCOOH and a higher amount of graphitic nitrogen bond of N-CNT850 suggest that these CNTs are particularly promising for applications in electrochemical fields.

Impact of organic pollutants from urban slum informal settlements on sustainable development goals and river sediment quality, Nairobi, Kenya, Africa

The UN Sustainable Development Goals highlight the myriad of socio-economic and environmental challenges occurring as a result of anthropogenic chemical pollution. Urban sediments from informal settlements (slums) on the Nairobi, Ngong and Mathare Rivers (n = 25), were evaluated for sediment quality. Microtox bioassay identified 8 sites as toxic, 9 as moderately toxic and 8 as non-toxic. Slum sediments were characterised by high total organic carbon and Rock-Eval pyrolysis revealed bound carbon from a mix of raw sewage and domestic refuse. Sediments from Kiambio, Kibera, Mathare and Kawangware slums contained high coprostanol at 55–298 μg/g and epicoprostanol at 3.2–21.7 μg/g confirming appreciable incorporation of untreated human faeces. Hormones, antianalgeiscs, antiinflamatories, antiepileptics and antibiotics most affected Mathare > Kiambio > Kibera > Mukuru > Kawangware slums. Carbamazepine, ibuprofen, diclofenac and acetaminophen concentrations are amongst the highest reported in Kenyan river sediments and were positively correlated with faecal steroids (sewage). Common persistent organic pollutants, such as organochlorine insecticides ΣDDT 1–59 μg/kg, mean 21.2 μg/kg, Σ16PAH 182–2218 μg/kg, mean 822 μg/kg and Σ30 PCB 3.1–157.1 μg/kg, mean of 21.4 μg/kg were between probable effect likely and unlikely sediment quality guidelines (SQG). PAH source ratios and parent to alkyl-PAH distribution suggested vehicle exhaust, power stations (heavy oil), kerosene (cooking oil) and other pollution sources. Trace metal concentrations As, Cd, Cr, Hg and Ni were below SQG whereas Pb exceeded the SQG. This multi-contaminant characterisation of sediment quality in Nairobi supports the development and implementation of policies to improve urban infrastructure to protect ecological and human health. It demonstrates the need for environmental geochemists to engage in the science-policy interface associated with both global and national development frameworks, with particular reference to the Sustainable Development Goals, New Urban Agenda, and Kenya’s Vision 2030.

Assessment of Ornamental Plants Tolerance for Acute Exposure of Acetaminophen and Methylparaben in Constructed Wetlands- a Preliminary Study

The study aims to select suitable ornamental plant species that can survive relatively with high concentrations of acetaminophen and methylparaben in constructed wetlands. Alternanthera spp, Asparagus aethiopicus and Chlorophytum comosum are examined to withstand three initial concentrations, 20, 100 and 200 mg/L of acetaminophen and methylparaben. A total of 21 plastic pails with each 3 L capacity consisting of nine pails are used for each pharmaceutical and personal care products (PPCPs) compounds (acetaminophen and methylparaben) for three ornamental plants (Alternanthera spp, Asparagus aethiopicus and Chlorophytum comosum), with three pails as plant controls. The results reveales that both Alternanthera spp and Chlorophytum comosum exhibite a good tolerance for acetaminophen with a reduction in the total chlorophyll content of about 4.4–12.3% and 3.9–31.9% for Alternanthera spp and Chlorophytum comosum, respectively. Moreover, it is evident that high concentrations (100 and 200 mg/L) of methylparaben adversely affects the chlorophyll content of the three involved plant species. These results indicate that ornamental plants play an important role in the phytoremediation of PPCPs and can be considered as an esthetic treatment for hospital wastewater.

Massive warfarin overdose management in an adolescent patient

Introduction Warfarin is a widely used oral anticoagulant with established reversal guidelines in the setting of a supratherapeutic international normalized ratio (INR). Limited literature exists on managing acute warfarin overdoses in patients who are not chronically anticoagulated. Case A 15-year-old male, with no indication for anticoagulation, presented to a pediatric emergency department after an acute 1,000 mg warfarin ingestion. He had no significant complaints upon presentation aside from a mild intermittent headache. His past medical history was significant for anxiety, depression, Tourette syndrome, attention deficit hyperactivity disorder, and polysubstance misuse. Computed tomography of his head was unremarkable and serum acetaminophen, salicylate, and ethanol concentrations were negative. Approximately 16 h post-ingestion, his INR was 1.9 with an increase to 3.3 by 26 h. The regional poison center was consulted and recommended, consistent with the CHEST guidelines, holding treatment with vitamin K until INR was >10 or if signs or symptoms of bleeding occurred. The patient was admitted for monitoring and by hospital day (HD) #4, his INR had risen to >11.8 at which point oral vitamin K 10 mg was administered. On HD #7, the patient was deemed stable for transfer to inpatient psychiatry after repeat INRs of 2.9 and 3.4. Discussion Case reports have demonstrated early administration of vitamin K can temporarily lower INR and prevent detection of rebound. The CHEST warfarin reversal guidelines describe the risks and benefits with respect to bleeding and thrombosis in the non-intentional overdose patient. Application and extrapolation of these guidelines to acute overdose in patients who lack an indication for anticoagulation may or may not be warranted. Conclusion While established clinical guidance exists on reversing a supratherapeutic INR in patients chronically anticoagulated with warfarin, the risks and benefits of extrapolating this approach are unclear in those who lack an indication for anticoagulation.

Early biomarkers predicting outcome in a porcine model of acetaminophen intoxication: A pilot study.

Acetaminophen intoxication has become the leading cause of acute liver failure (ALF) in Europe and the USA. To identify early biomarkers in order to predict the development of ALF in a porcine model of acetaminophen intoxication. Six German Landrace pigs received a single acetaminophen bolus of 1 g/kg body weight via a jejunal catheter. Cytokines and laboratory parameters were analyzed at 8-hour intervals for a total of 40 h. Three of the 6 animals survived the intoxication. The nonsurviving animals had an increase in serum lactate and interleukin (IL)-6, with a simultaneous decrease in prothrombin time (PT) and albumin concentration 8 h after intoxication. In all nonsurviving animals, elevated levels of tumor necrosis factor alpha (TNF-α) at baseline before intoxication and during the course of ALF were observed. The acetaminophen serum concentrations and toxicokinetics did not differ between the nonsurviving and surviving animals. Methemoglobinemia was proportional to the administered doses and acetaminophen blood levels, but methemoglobinemia did not affect survival. Tumor necrosis factor alpha, IL-6, lactate, prothrombin time, and albumin blood concentration were identified as early predictors of outcome after acetaminophen intoxication. An elevated TNF-α level before acetaminophen exposure was the earliest prognostic marker for a lethal outcome. Therefore, it could serve as a very early indicator of prognosis.