Kings_College_Criteria_for_Acetaminophen_Toxicity_guideline v.1
The KCC are a well-accepted criteria that show the degree of multiorgan dysfunction from acetaminophen-induced liver failure. Used alone or with serum lactate and phosphate, the KCC can predict patients with poor prognosis.
King's College Criteria for Acetaminophen Toxicity recommends who should be immediately referred for liver transplant.
Use to determine which patients with fulminant hepatic failure (FHF) should be referred for liver transplant. Apply to all (acute or chronic) acetaminophen ingestions with signs of severe acute liver injury. King's College Criteria for Acetaminophen Toxicity shows the degree of multiorgan dysfunction from acetaminophen-induced liver failure. Used alone or with serum lactate and phosphate, the KCC can predict patients with poor prognosis. Formula: Yes No Questions. Yes=1, No=0. - Arterial pH < 7.30 - INR > 6.5 (PT > 100 sec) - Creatinine 3.4 mg/dL (300 µmol/L) - Grade III or IV hepatic encephalopathy Other predictors of poor prognosis without transplant: - Lactate > 3.5 mmol/L after fluid resuscitation (<4 hrs) OR lactate > 3 mmol/L after full fluid resuscitation (12 hours) - Phosphate > 3.75 mg/dL (1.2 mmol/L) at 48-96 hours Note: While not part of the King’s Criteria, hyperlactatemia and hyperphosphatemia are strong predictors of poor prognosis for survival without transplantation.
1. O'Grady J, Alexander G, Hayllar K, Williams R (1989). Early indicators of prognosis in fulminant hepatic failure. Gastroenterology 97 (2): 439–45 2. Bailey B, Amre DK, Gaudreault P. Fulminant hepatic failure secondary to acetaminophen poisoning: a systematic review and meta-analysis of prognostic criteria determining the need for liver transplantation. Crit Care Med. 2003 Jan;31(1):299-305. 3. Bernal W, Donaldson N, Wyncoll D, Wendon J. Blood lactate as an early predictor of outcome in paracetamol-induced acute liver failure: a cohort study. Lancet. 2002; 359(9306): 558-63. PMID:11867109. 4. Schmidt LE, Dalhoff K. Serum phosphate is an early predictor of outcome in severe acetaminophen-induced hepatotoxicity. Hepatology. 2002; 36(3):659–665. doi: 10.1053/jhep.2002.35069. 5. Riordan SM, Williams R. Treatment of hepatic encephalopathy. N Engl J Med. 1997 Aug 14;337(7):473-9. 6. Goldfrank's Toxicologic Emergencies, 10th Edition.
OBSERVATION.kings_college_criteria_for_acetaminophen_toxicity.v0
