Paracetamol overdose Flashcards
Which bloods would you test for in a paracetamol overdose?
paracetamol level
coag/INR
U+E’s
LFTs
FBC
Bicarb
GLucose
What is the treatment for paracetamol overdose?
n-acetylcysteine= NAC= parvolex
What is the dosing of NAC dependent on?
weight!! not paracetamol conc dependent
Which is a serious complication of paracetamol overdose?
fulminant hepatic necrosis
If a patient has paracetamol level >700mg/L, what other management might they require?
haemodialysis
NAC dose should be doubled
What is the name of the criteria for paracetamol toxicity in considering liver transplant?
king’s criteria
Which system excretes paracetamol?
kidneys
Which is the toxic metabolite generated in paracetamol overdose?
NAPQI, paracetamol is converted by CYP450 to this compound when the other pathway becomes saturated (pathway that converts para to therapeutic compound).
Which endogenous enzyme inactivates NAPQI
glutathione
Which website can be used to input different drugs to determine treatment?
toxbase
How many hours after ingestion of paracetamol should bloods be taken?
4 hours
List two prognostic factors for paracetamol overdose
pH <7.3
Prothrombin time >100 sec
creatinine >300
Encephalopathy
List two risk factors for increased risk of hepatotoxicity with paracetamol overdose?
1 Patients taking liver enzyme-inducing drugs (rifampicin, phenytoin, carbamazepine, St John’s Wort)
2 Patients with a history of chronic alcohol excess
3 Malnourished patients (e.g. anorexia nervosa) or patients who have not eaten for a few days, due to depletion of glutathione.
Does acute alcohol intake worsen paracetamol overdose?
no!
