ovedose

Question 1

why is it important to know if overdoes was staggered or all at once for paracetamol

Answer 1

in single acute overdoses (all at once), treatment decisions are based on the paracetamol level plotted against time on the nomogram (Rumack-Matthew Nomogram)

BUT in staggered overdoses:

The nomogram cannot be used reliably because there is no clear time of ingestion.
Blood paracetamol levels might appear low or normal — even when liver toxicity is already happening.
Risk of delayed liver injury is much higher than in single ingestions.

Question 2

staggered OD definition

Answer 2

A staggered overdose happens when the person takes multiple doses of paracetamol over time (usually over >1 hour, typically over several hours or even days) rather than in one single overdose.

Question 3

Symptoms of liver injury in paracetamol

Answer 3

nausea, vomiting, RUQ pain, raised ALT)

Question 4

THE RELATIONSHIP BETWEEN INR AND PARACETAMOL

Answer 4

remember the liver makes clotting factors and so t inhibits some clotting factors especially number 7 so it takes the blood longer to clot.

but its normal to have raised INR in the absence of hepatic injury but if its raised a LOT then this could mean significant liver injury.

in early phases INR MAY BE NOMRAL e,g less than 24 hours since overdose

chat GPT? if at any point it reaches >1.3 start nac regardless of paracetamol level

Question 5

WHICH LIVER MARKER IS MORE SPECIFIC

Answer 5

ALT

ast - found in other places, like muscles so wil increase in muscle damage

Question 6

a normal iNR

Answer 6

0.8-1.2

2-3 - PEOPLE ON WARFARIN