Paracetamol Overdose Flashcards
1
Q
Pathophysiology
A
Overdose of paracetamol uses up glutathione as too much NAPQI produced.therefore oxidative stress increases which causes damage to liver
2
Q
Presentation
A
RUQ pain Nausea and vomiting Jaundice Drowsiness Cerebral oedema - pupillary light response Haematuria and proteinuria
3
Q
Treatment
A
A-E
N - acetylcysteine - replaces glutathione antioxidant so paracetamol can be metabolised
4
Q
Investigations
A
Abdominal exam Obs Bloods - LFTs, U+Es, FBC, NAPQI Mini mental state examination Urine dipstick
5
Q
Criteria for safe discharge
A
After 20 hrs of acetylcysteine and no longer required Paracetamol level below 10mg/l Normal ALT Normal creatinine Normal INR Assessed by mental health team
6
Q
Staggered overdose
A
Give N-acetylcysteine immediately regardless of plasma paracetamol concentration
7
Q
Complications of N - acetylcysteine
A
Commonly causes anaphylaxis therefore infused over 1 hour
If anaphylaxis, stop acetylcysteine then infuse at slower rate
8
Q
Criteria for liver transplantation
A
pH < 7.3 after 24 hrs of ingestion
Or all of:
- PT time > 100seconds
- creatinine > 300 micrommol/l
- grade III/IV encephalopathy
9
Q
Risk factors
A
If taking liver enzyme inducing drugs such as
- St Johns Wart
- Rifampcin
- phenytoin
- carbamazepine
- chronic alcohol
If malnourished
