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#Phase 2.2: Acute Care > Paracetamol Overdose > Flashcards

Paracetamol Overdose Flashcards

1
Q

What is the most common Overdose seen in the UK?

A

Paracetamol overdose

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2
Q

What does Risk Assessment of a Paracetamol Overdose pt involve? (7 things)

A
  1. Date of ingestion (was there a delay in CF?)
  2. Timing of ingestion (single overdose / staggered)
  3. Time of last ingestion
  4. Weight
  5. Pregnancy
  6. Total amount ingested
  7. Current suicidal risk
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3
Q

If a pt is above 110kg, what should you do for weight calculations of meds?

A

Use 110kg as maximum weight

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4
Q

How does Pregnancy affect weight calculations of meds? (2 things)

A
  1. Use Pre-preg weight to determine toxicity
  2. Current weight for Tx
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5
Q

What should you consider if a pt has a high current suicidal risk?

A

Have a MH nurse stay with them

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6
Q

What ACUTE dose of Paracetamol will cause Toxicity?

A

Over 75mg / kg

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7
Q

What STAGGERED dose of Paracetamol will cause Toxicity?

A

Over 150mg / kg over 24 hours

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8
Q

What ACUTE dose of Paracetamol will kill you (or haver serious fx)? (2 things)

A
  1. 150mg / kg
  2. 12g +
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9
Q

If timing of ingestion is unknown, how should you treat the pt?

A

As staggered overdose

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10
Q

What are the RF for developing toxicity with Paracetamol overdose? (2 things)

A
  1. Liver enzyme-inducing drugs
  2. Malnourished
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11
Q

What are some liver enzyme-inducing drugs that increase the risk of developing Toxicity with Paracetamol Overdose? (5 things)

A
  1. Rifampicin
  2. Phenytoin
  3. Carbamazepine
  4. Chronic alcohol excess (not ACUTE tho)
  5. St John’s Wort
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12
Q

How long does it take Paracetamol to reach peak Conc once ingested?

A

4 hours

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13
Q

What is the half life of Paracetamol?

A

2 hours

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14
Q

How early after Paracetamol ingestion can levels be measured?

A

4 hours after last ingestion
(can’t interpret levels before 4 hours)

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15
Q

How long after ingestion can Paracetamol levels be detected for?

A

24 hours
(but any detectable level after 16 hours is concerning)

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16
Q

What Toxic metabolite is Paracetamol converted to?

A

NAPQI

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17
Q

What are the bad things NAPQI can lead to? (3 things)

A
  1. Oxidative damage
  2. Mitochondrial dysf
  3. Hepatocellular injury
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18
Q

What are the CF in the early stages of Paracetamol overdose?

A

Asymptomatic for a bit

19
Q

How long does it take for FIRST CF of Paractamol overdose to appear?

A

12-36 hours

20
Q

What are the FIRST CF of Paracetamol overdose to appear?

A

Abd pain

21
Q

How long does it take for the SECOND batch of CF of Paractamol overdose to appear?

A

48-72 hours

21
Q

How long does it take for the SECOND batch of CF of Paractamol overdose to appear?

A

48-72 hours

22
Q

What are the SECOND batch of Paracetamol overdose CF? (10 things)

A
  1. Confusion / Coma
  2. Nausea
  3. Jaundice
  4. Vomiting
  5. Tachycardia / hypotension
  6. Asterixis (flapping hands)
  7. RUQ pain
  8. Hepatic encephalopathy
  9. AKI (oliguria / anuria)
  10. Coagulopathy (INR 1.5+)
23
Q

What does Hepatic encephalopathy w Coagulopathy indicate?

A

Acute liver failure (ALF)

24
Q

What do Paracetamol overdose pt with ALF require?

A

Urgent transfer to transplant unit

25
Q

What is Dx of Paracetamol overdose based on?

A

Hx

26
Q

What bloods should you do for Paracetamol overdose? (8 things)

A
  1. FBC
  2. UnE
  3. LFT
  4. Bone profile
  5. ABG
  6. BG
  7. Paracetamol levels
  8. Salicylate levels
27
Q

What investigation is used to determine if NAC should be used for Paracetamol overdose Tx?

A

Nomogram

28
Q

How do you use a Nomogram for Paracetamol overdose? (2 steps)

A
  1. Plot paracetamol conc vs time of ingestion
  2. If conc lies in Tx line –> administer NAC
29
Q

What Tx should you give if ingestion is 150+ mg/kg + presented within 1 hour?

A

Activated charcoal 50g

30
Q

What is the GOLD standard Tx for Paracetamol overdose?

A

NAC
(N-acetylcysteine)

31
Q

What is the NAC regimen called?

A

Standard 21 hour regimen

32
Q

What is the Standard 21 hour regimen of NAC? (3 steps)

A
  • 1st infusion (@ 1 hour): 150mg/kg NAC + 200ml 5% dextrose / 0.9% NaCl
  • 2nd infusion (@ 4 hours): 50mg/kg NAC + 500ml 5% dextrose / 0.9% NaCl
  • 3rd infusion (@ 16 hours): 100mg/kg NAC + 1L 5% dextrose / 0.9% NaCl
33
Q

What should you do for after the 21 hour regimen of NAC?

A

Check bloods for signs of Hepatic impairment (aka coagulopathy / abn LFT / renal function)

34
Q

What should you do if there are signs of Hepatic impairment even after 21 hour regimen of NAC? (2 things)

A
  1. Discuss with liver transplant centre
  2. Give 3rd infusion of NAC continuously until further advice
35
Q

What are the Side fx of NAC 21 hour regimen?

A

Anaphylactoid reaction (30% of pt)

36
Q

What is an Anaphylactoid reaction?

A

Same CF of Anaphylaxis but not IgE mediated

37
Q

What are the CF of Anaphylactoid reaction to 21 hour regimen of NAC? (6 things)

A
  1. Nausea
  2. Vomiting
  3. Angioedema (eyes + lips swelling)
  4. Tachycardia
  5. Bronchospasm
  6. Urticarial rash
    (shock is uncommon)
38
Q

What should you do if pt has Anaphylactoid reaction to 21 hour regimen of NAC? (4 steps)

A
  1. Temporarily stop infusion
  2. Give chlorphenamine (anti-histamine)
  3. Give nebulized salbutamol
  4. Restart infusion (once reaction settles)
39
Q

When can you End Tx of Paracetamol overdose? (2 things)

A
  1. INR less than 1.3 + ALT normal // OR //
  2. INR less than 1.3 + ALT raised but less than 2x upper limit + not over double admission ALT
40
Q

What criteria is used to refer Paracetamol overdose pt for liver transplant?

A

Kings college criteria

41
Q

What are the Kings college criteria? (5 things)

A
  1. Arterial pH: less than 7.3 aftr resus + over 24 hours since ingestion
  2. Lactate: 3+ // OR //
  3. Hepatic encephalopathy grade 3+
  4. Creatinine: 300+
  5. INR: 6.5+
42
Q

What should you do with a Paracetamol overdose pt once medically cleared?

A

Transfer to inpatient MH bed

#Phase 2.2: Acute Care (31 decks)

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