paracetamol OD

Question 1

20 y.o. uni student brought to A+E department by friend after taking an overdose of paracetamol ~20 tablets about 5 hours ago

she is fully conscious and cooperative but withdrawn and admits to feeling depressed recently

(a) what is the most important ix to undertake at this stage and why?

Answer 1

plasma paracetamol levels

concentration will guide mx

Question 2

(b) what would you administer orally to reduce absorption of the paracetamol?

Answer 2

activated charcoal

Question 3

(c) list 3 other important ix that would also be undertaken and why

Answer 3

1. coag screen: hepatoxicity of paracetamol may impair synthesis of clotting factors
2. LFTs: same as above
3. U+Es: assess renal damage and electrolyte levels / for baseline measures
4. ABG: paracetamol OD can cause acidosis

Question 4

(d) what is the most important rx of paracetamol OD at this stage and how does it work?

Answer 4

N-Acetyl-Cysteine (Parvolex)

glutathione donor and therefore serves to help bind toxic metabolites

Question 5

(e) over the next 3 days, she becomes mildy jaundiced.

then, over the subsequent 48 h, she becomes increasingly jaundiced, agitated and confused.

what is the likely dx and what action can be taken?

Answer 5

hepatic encephalopathy due to liver failure

refer to tertiary centre for liver transplant