Paracetamol overdose Flashcards
What is paracetamol the most common agent of?
Most common agent for intentional self-harm in the UK.
What is paracetamol also knwon as?
Acetaminophen
How can a paracetamol overdose present?
Asymptomatic
What are the possible symptoms of a paracetamol overdose?
Nausea and vomiting
Loin pain
Haematuria and proteinuria
Jaundice
Abdominal pain
What is the more severe presentation of a paracetamol overdose?
Coma
What type of blood gas does a paracetamol overdose present with?
Severe metabolic acidosis
What does a paracetamol overdose result in a build up of?
NAPQI
What is the management of a patient who presents within 1 hour?
Activated charcoal
What is the management of a paracetamol overdose If staggered overdose or ingestion >15 hours ago?
Start N-acetylcysteine immediately
What is the management of a paracetamol overdose if ingestion <4 hours ago?
Wait until 4 hours to take a level and treat with N-acetylcysteine based on level
What is the management of a paracetamol overdose If ingestion 4-15 hours ago?
Take immediate level and treat based on level
What adverse effect can Aceytlcysteine cause?
Acetylcysteine commonly causes an anaphylactoid reaction (non-IgE mediated mast cell release).
How can anaphylactoid reactions be managed?
By stopping the infusion, then restarting at a slower rate
Which patients have an increased risk of toxicity from a paracetamol overdose?
Patient on long-term enzyme inducers
Regular alcohol excess
Pre-existing liver disease
Glutathione-deplete states: eating disorders, malnutrition and HIV.
What is the decision to treat a paracetamol overdose based on?
Deciding whether to treat is based on a nomogram
If paracetamol levels are above the treatment line then start NAC.
What investigations should be carried out for someone presenting with a paracetamol overdose?
FBC
Urea and Electrolytes
INR
Venous gas
What is the most imporant prognostic marker in paracetamol overdose?
Arterial blood gas pH
What type of reaction is an anaphylactoid reaction?
Mon-IgE mediated mast cell release
When might you consider a liver transplant in someone who has taken a paracetamol overdose?
Criteria: pH < 7.3 more than 24 hours after ingestion
