Paracetamol overdose

Question 1

Define Paracetamol overdose

Answer 1

Over 150mg/kg may be fatal–usually around 4g within 24h

PROMPT treatment to avoid long term damage

Question 2

Aetiology and risk factors of paracetamol overdose

Answer 2

Aetiology-Breakdown of paracetamol to NAPQI-very toxic. When enzymes overloaded and lack cysteine-accumulate NAPQI-oxidative damage to liver and death

History of self harm
Hx of pain reflief
Glutathione deficiency-malnourish, eating disorder
Drugs than reduce p450-Rifamicin, st johns wart

Question 3

Epidemology of Paracetamol Overdose

Answer 3

Most frequently used drug for intentional overdose–48% of overdose take in

Question 4

Sign and symptoms of paracetamol Overdose

Answer 4

Within few hours--nausea and vomiting
Right upper quadrant pain
Jaundice
Hepatomegaly
Asterixis (encelopathy)
Loin pain

Question 5

Investigations for paracetamol Overdose

Answer 5

Serum paracetamol lvl-high
ALT-high
INR/PT/APTT-high

Hypoglycemia or high Creatinine-> fulminant liver failure and need senior advice

VBG-maybe lactic acidotic

Question 6

Treatment for paracetamol overdose

Answer 6

If early (<4h)-gastric lavage
If serum paracetamol above line-acetyl cysteine
if suspect large overdose-, just start N-Acetyl cysteine