Liver Resection, Paracetamol Administration
Conditions
Brief summary
This observational study will assess the metabolic pathways of paracetamol that are utilised after liver resection.
Detailed description
Paracetamol is normally metabolised by the glucuronidation and sulfation of paracetamol to non toxic end products. If paracetamol is administered in supra-therapeutic doses this pathway becomes saturated and an alternative pathway is utilised. This results in a toxic metabolite called N-acetyl-p-benzoquinone imine (NAPQI). If NAPQI is not metabolised by glutathione to cysteine and mercapturic acid, then NAPQI bind to hepatic cells resulting in necrosis and hepatotoxicity. Therefore the investigators plan to measure the levels of the paracetamol metabolites in patient undergoing liver resection. Patients will undergo liver resection according to their onco-surgical requirements. As part of the normal post operative care they will receive 1g paracetamol every six hours unless stated otherwise by the operating surgeon. Urinary samples will be taken for the first 4 post operative days and used for analysis of the urinary paracetamol metabolite levels.
Interventions
OTHERParacetamol (observation of routine administration)
Normal administration of paracetamol as prescribed by operating surgeon
Sponsors
NHS Lothian
University of Edinburgh
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients undergoing liver surgery
Exclusion criteria
* Contra-indication to paracetamol * Inability to give written, informed consent. * Jaundice (Bilirubin \> 100 μmol/L). * Liver resection combined with secondary surgical procedure. * Age \< 18 years. * Pregnant women.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Urinary cysteine | Post operative days 1-4 |
Secondary
| Measure | Time frame |
|---|---|
| mercapturic acid | post operative days 1-4 |
| Glutathione | day of surgery and post operative days 1 and 3 |
| Paracetamol level | day of surgery and post operative days 1 and 3 |
Other
| Measure | Time frame |
|---|---|
| Glucuronamide | Post-operative days 1-4 |
| Post-operative blood tests (FBC, U&E, LFTs, Coag) | Post-operative dyas 1-7 |
| Sulphate | Post-operative days 1-4 |
| 5-oxoproline | Post-operative days 1-4 |
| Complications | Day of surgery and post-operative days 1-30 |
Countries
United Kingdom
Outcome results
None listed