Paracetamol poisoning

Question 1

What is the pathway of paracetamol breakdown?

Answer 1

Paracetamol->NAPQUI->glutathione conjugate->cysteine conjugate

Question 2

Why is glutathione depletion dangerous for paracetamol takers?

Answer 2

Glutathione acts as a conjugate to remove NAPQUI, which is a toxic intermediate

Question 3

What doses in mg/kg are considered very low risk, rare risk, possible risk?

Answer 3

<75 75-150 >150

Question 4

What is the cut off time to trust bloods on paracetamol?

Answer 4

4 hours

Question 5

What is the number of hours for the best chance of reversal of paracetamol poisoning?

Answer 5

8 hours

Question 6

Which liver enzyme is extremely raised in paracetamol poisoning?

Answer 6

ALT

Question 7

What are the side effects of acetylcysteine?

Answer 7

Anaphylactoid features occur in approximately 10-15 % of cases • Flushing, urticaria, pruritus, bronchospasm • Histamine mediated • (Rarely) angio-oedema, wheezing, respiratory distress, hypotension