1H NMR spectra of urine and plasma from subjects who had taken
paracetamol (
acetaminophen) at a therapeutic dose or in self-
poisoning episodes (both fatal and nonfatal) are compared. They provide convenient metabolic profiles. For overdose cases, intense resonances corresponding to high levels of both
drug and endogenous metabolites are observed. The ratios of
glucuronide to
sulfate conjugates are unusually high in urine from overdose cases. Elevated levels of the cysteinyl and N-acetyl cysteinyl conjugates reflect increased
glutathione conjugation in the liver. The observed excretion of high levels of
amino acids by overdose subjects is suggestive of
drug-induced hepatic damage. No resonances for
drug metabolites are detected in plasma samples. However, characteristic and abnormally intense resonances for the
amino acids Phe, Tyr, His, Gln, Pro, Ala,
Val, Lys, Met, Ser, and Thr are indicative of severe
liver failure and disruption of normal deamination and transamination processes.