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Acetaminophen (N-Acetyl-p-Aminophenol; APAP)

Definition

• Nonopioid analgesic, antipyretic

Use

• Relief of pain, such as headaches and toothaches
• Reduction of fever

Interpretation

• Screen of urine: indication of exposure
• Screen of serum: used to assess potential toxicity
• Normal range: 5 " “20 Ž ¼g/mL serum
• Potentially toxic: >150 Ž ¼g/mL measured 4 hours postdose

Limitations

• Screening
  • Serum/urine: colorimetric or immunoassay on automated chemistry analyzers
    • High bilirubin concentrations [>50 Ž ¼g/mL] may cause false-positive results with immunoassay-based tests.
    • Plasma may be tested in place of serum. Anticoagulants such as EDTA and heparin do not generally interfere with the assay.
    • Do not use whole blood.
• Confirmation:
  • Serum/urine " “HPLC or GC/MC
  • APAP is highly conjugated by glucuronidation and sulfation.
  • An assay that includes a hydrolysis step provides total APAP levels, which are not useful for assessing toxicity.

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