Day 3- APAP Toxicity Flashcards
How is APAP metabolized?
What is the toxicity mechanism of NAPQI?
What are the NAPQI high dose ingestion amounts?
Glucocorinidation, Sulfation, Oxidized to NAPQI(in non toxic doses this is then conjugated with glutiathione and eliminated in urine).
Gluco and Sulfa pathways saturate, NAPQI exhausts glutiathione and then causes hepatoxicity.
> 10g in adults, 150mg/kg in children.
What are your risk factors for APAP toxicity?
Which medications increase the risk of APAP toxicity??
What is stage 1 of APAP overdose?
Chronic alcohol use, medications that lower gastric emptying like Opiates, Anticholinergics, concomitant APAP product use, old age, malnutrition, medications that alter enzyme function.
Phenytoin, smoking, phenobarbital, oxycarbazepine, rifampin, carbazepine, St. Johns Wort. G-PACMAN.
0-24 hours, N/V, malaise or ASYMPTOMATIC. Normal labs.
What is Stage 2 of APAP overdose?
What is Stage 3 of APAP overdose?
What is Stage 4 of APAP overdose?
24-72 hours, initial symptoms may resolve, right upper quadrant pain, anorexia. Elevated LFT’s, bilirubin, BUN, and SCr.
72-96 hours, N/V, jaundice, hypoglycemia, bleeding, coma, seizure, encephalopathy, death. ALT and AST >10,000, elevated PT/INR, lactic acidosis, rising bilirubin.
Months, recovery.
What is the difference between acute and chronic toxicity?
How do you check serum APAP levels in toxicity?
How do you treat APAP toxicity less than 4 hours after ingestion?
Chronic is ingestions that exceed 8 hours, ingestions of 4g>24 hours with risk factors.
If ingestion time known, check 4 hours after ingestion, if unknown draw immediately. Apply to Nomogram if above treatment line.. treat. ONLY FOR ACUTE OVERDOSE.
Activated Charcoal(1g/kg max 50 g)/. CI’d in depressed mental status. NAC(most important step)
What special things to know about mucomist?
What to know about Acetadote?
PO, 72 hour protocol, Anaphylaxis with IV 140 mg/kg X 1 then 70 mg/kg q4h for 17 doses. N/V, can dilute in soft drinks or juice, can administer anti emetics.
IV, 20 hour protocol, usually preferred, vomiting, anaphylaxis, CI to oral administration.
