Salivary paracetamol: evaluation of a colorimetric method in assessing deliberate self-poisoning

This version was published on 1 March 2009

Ann Clin Biochem 2009;46:149-151
© 2009 Association for Clinical Biochemistry


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Joshua Ryan1,
Christine Mandelt1,
Heidi Wade1 and
Samuel D Vasikaran1,2

1 Core Clinical Pathology and Biochemistry Department, PathWest-Royal Perth Hospital; Department of Emergency Medicine, Royal Perth Hospital, Box X2213 GPO, Perth, WA 6847;
2 School of Pathology and Laboratory Medicine, University of Western Australia, Perth, WA, Australia

Corresponding author: Dr Samuel Vasikaran. Email: samuel.vasikaran{at}

Background: In the laboratory evaluation of suspected paracetamol poisoning,a non-invasive sample type that avoids venepuncture would bean attractive alternative to plasma, particularly in the paediatricsetting. Salivary paracetamol measurement has not previouslybeen evaluated in the published medical literature in the settingof deliberate self-poisoning (DSP).

Methods: In-house validation experiments (recovery, stability and lowerlimit-of-detection) were performed on pooled saliva samplesusing a Roche Acetaminophen assay on a Roche/Hitachi 917 analyser.A clinical study of comparison of paired saliva and plasma sampleswas also conducted involving adult patients presenting withDSP of paracetamol, the results of which were published previously.

Results: The validation experiments using pooled saliva samples showed: (i) mean recovery (paracetamol concentration 37.5–525 mg/L) 100.01% (±0.02 SD); (ii) precision of repeated assay over 24-h period CV <4%; (iii) lower limit-of-detection 0.9 mg/L. The clinical study of 21 patients with mean plasma paracetamol concentration of 48 mg/L (range 0–130) and mean saliva concentration 62 mg/L (range 0–183) showed good correlation between saliva and plasma concentrations (r2= 0.91).

Conclusions: The Roche Hitachi 917 Acetaminophen assay is suitable for themeasurement of paracetamol in saliva. Further studies comparingplasma and saliva samples from patients with DSP and plasmaparacetamol concentrations in the hepatotoxic range are warranted.If salivary samples are suitable for risk-stratifying patientswith paracetamol DSP, venepuncture may be avoided, which wouldbe attractive, especially in the paediatric setting.

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