Paracetamol Overdose

Question 1

What dose can be fatal in adults?

Answer 1

12g or 150mg per kg

Question 2

What are initial clinical manifestations?

Answer 2

None or vomiting +/- RUQ pain

Question 3

What are later clinical manifestations?

Answer 3

Jaundice, encephalopathy, +/- AKI

Question 4

What investigations would you do?

Answer 4

Blood paracetamol at 4h post ingestion, INR, U&E, LFT, ABG

Question 5

What can you give for GI decontamination?

Answer 5

Activated charcoal

Question 6

What drug do you give if the patient is above the treatment line?

Answer 6

N-Acetylcysteine

Question 7

What is a common side effect of acetylcysteine?

Answer 7

Rash

Question 8

How do you monitor patients?

Answer 8

INR, U&E, LFT

Question 9

What is a potential complication?

Answer 9

Liver failure

Question 10

What criteria is used to diagnose paracetamol-induced liver failure?

Answer 10

King’s College

Question 11

What are the criteria for paracetamol-induced liver failure?

Answer 11

Arterial pH <7.3 24h after ingestion or PT >100s + creatinine >300 + grade III/IV encephalopathy

Question 12

What drug is prescribed in alcohol withdrawal?

Answer 12

Chlordiazepoxide

Question 13

What drug is prescribed to reverse benzodiazepine overdose?

Answer 13

Flumezanil