The hypotension caused by intravenous paracetamol in septic shock patients: A single center placebo controlled randomized study

Khalil, Ayah M; Mukhtar, Ahmed M; Lotfy, Ahmed M; Abu EL-Fotuh, Karima; Zalat, Zeinab A

doi:10.21608/aijpms.2023.221239.1223

The hypotension caused by intravenous paracetamol in septic shock patients: A single center placebo controlled randomized study

Document Type : Original research articles

Authors

¹ Department of Clinical Pharmacy ,Cairo University Hospitals(Kasr alainy), Cairo, Egypt

² Department of Anesthesia, Intensive Care and Pain Management, Cairo University, Faculty of Medicine, Cairo, Egypt

³ Department of Clinical Pharmacy, Faculty of Pharmacy (Girls), Al-Azhar University, Cairo, Egypt

10.21608/aijpms.2023.221239.1223

Abstract

According to the product information for parenteral paracetamol, fewer than 1% of patients will have more severe adverse effects like hypotension. However, a number of studies suggest that the prevalence of paracetamol induced hypotension may be higher than the drug's producers. We carried out prospective, controlled, randomized research to compare the clinical implications of intravenous paracetamol bolus versus intravenous paracetamol extended infusion. The 61 adult septic shock were divided into three groups by randomization: Bolus group who received paracetamol 1g/100ml infused over 15 minutes, while the extended infusion group who received paracetamol 1g/100ml infused over 3 hours. The control group who received normal saline 100ml infused over 15 minutes. The main outcome was the incidence and prevalence of reduced blood pressure, which was detected by a systolic blood pressure drop of ≥ 20٪ from baseline. Mean arterial pressure, vasopressor infusion flow rate, and both diastolic and systolic blood pressure did not change significantly according to statistical analysis between the three groups at baseline, one, three, or six hours after the intervention. The incidence of hypotension was 19% (4 of 21 ) within the control or normal saline group, 50% (10 of 20 ) within the bolus group, and 35% (7 of 20) within the extended infusion group. The prevalence of hypotensive episodes was greater in the bolus group, but there was no clinically meaningful difference between intravenous paracetamol prolonged infusion and bolus. We do not need to administer paracetamol as a prolonged infusion to prevent the negatively impacted of paracetamol.

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