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HelpMayo Test ID ACMA Acetaminophen, Serum
Specimen Required
Collection Container/Tube:
Preferred: Serum gel
Acceptable: Red top
Submission Container/Tube: Plastic vial
Specimen Volume: 0.5 mL
Collection Instructions:
1. Serum gel tubes should be centrifuged within 2 hours of collection.
2. Red-top tubes should be centrifuged, and the serum aliquoted into a plastic vial within 2 hours of collection.
Useful For
Monitoring toxicity in overdose cases
Method Name
Photometric
Reporting Name
Acetaminophen, SSpecimen Type
SerumSpecimen Minimum Volume
0.25 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum | Refrigerated (preferred) | 7 days | |
| Frozen | 180 days | ||
| Ambient | 24 hours |
Reject Due To
| Gross hemolysis | Reject |
Clinical Information
Acetaminophen (found in Anacin-3, Comtrex, Contac, Datril, Dristan, Excedrin, Nyquil, Sinutab, Tempera, Tylenol, Vanquish, and many others) is an analgesic, antipyretic drug lacking significant anti-inflammatory activity. It is metabolized by the liver with a normal elimination half-life of less than 4 hours. In normal therapeutic doses, a minor metabolite, possessing electrophilic alkylating activity, readily reacts with glutathione in the liver to yield a detoxified product. In overdose situations, liver glutathione is consumed and the toxic metabolite (postulated metabolite: benzoquinone) reacts with cellular proteins resulting in hepatotoxicity, characterized by centrilobular necrosis and possible death if untreated. N-acetylcysteine can substitute for glutathione and serves as an antidote.
Serum concentration and half-life are the only way to assess degree of intoxication in early stages since other liver function studies (eg, bilirubin, liver function enzymes) will not show clinically significant increases until after tissue damage has occurred, at which point therapy is ineffective.
Interpretation
The normal half-life is less than 4 hours, while the toxic half-life is greater than 4 hours.
The toxic level is dependent on half-life. When the half-life is 4 hours, hepatotoxicity generally will not occur unless the concentration is above 150 mcg/mL. The level at which toxicity occurs decreases with increasing half-life until it is encountered at values as low as 50 mcg/mL when the half-life reaches 12 hours.
For half-life determination, draw 2 specimens at least 4 hours apart and note the exact time of each draw. Half-life can be calculated from the concentrations and the time interval.
Cautions
First specimen should be drawn no sooner than 2 hours postingestion.
Clinical Reference
Rumack BH, Peterson RG: Acetaminophen overdose: incidence, diagnosis, and management in 416 patients. Pediatrics Nov 1978;62:898-903
Method Description
The assay is based on a homogeneous enzyme immunoassay technique used for the quantitative analysis of acetaminophen in human serum or plasma. The assay is based on competition between drug in the sample and drug labeled with the enzyme glucose-6-phosphate dehydrogenase (G6PDH) for antibody binding sites. Enzyme activity decreases upon binding to the antibody, so the drug concentration in the sample can be measured in terms of enzyme activity. Active enzyme converts oxidized nicotinamide adenine dinucleotide (NAD+) to NADH, resulting in an absorbance change that is measured spectrophotometrically. Endogenous serum G6PDH does not interfere because the coenzyme functions only with the bacterial (Leuconostoc mesenteroides) enzyme employed in the assay.(Package insert: Roche Acetaminophen Gen. 2 reagent, Roche Diagnostic Corp, Indianapolis, IN, 04/2016)
Day(s) Performed
Monday through Sunday
Report Available
Same day/1 daySpecimen Retention Time
1 weekPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.CPT Code Information
80143
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| ACMA | Acetaminophen, S | 3298-7 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| ACMA | Acetaminophen, S | 3298-7 |