Week 15 - Jaundice (Hepatitis And Paracetamol OD) Flashcards
What is the route of transmission for Hep A, B, C , D and E?
Hep A = faecal-oral
Hep B = blood/bodily fluids
Hep C = blood/bodily fluids
Hep D = blood/bodily fluids
Hep E = faecal-oral
Are Hep A, B, C , D and E acute or chronic infections ?
Hep A = acute
Hep B = acute and chronic
Hep C = acute and chronic
Hep D = acute and chronic
Hep E = chronic
What are the 4 main functions of the liver ?
- produce clotting factors
- store excess glucose as glycogen
- metabolism (carbs, fats, proteins)
- destroy harmful substances (drugs, bacteria, cellular debris etc)
What are the 3 most common causes of liver cirrhosis in the western world ?
- alcohol-related liver disease
- non-alcoholic fatty liver disease
- chronic viral hepatitis
What is important to know regarding admission of a patient who has taken a paracetamol overdose ?
- number of tablets taken ?
- if they were all taken at once or staggered ?
- when was the overdose ?
- was it only paracetamol ?
- do they take any other regular medications ?
What examination findings indicate development of hepatotoxicity ?
- confusion due to hepatic encephalopathy
- flapping hand tremor (liver asterixis)
- jaundice in skin or eyes
- bruised skin
- bleeding gums
- tenderness in RUQ
- hepatomegaly
What treatment is given in a paracetamol overdose ? What is its MOA ?
N-Acetylcysteine (IV)
Acts as a Glutathione donor, preventing toxic buildup of NAPQI
When do you administer N-Acetylcysteine ?
In paracetamol overdose patients when….
- plasma-paracetamol conc is above the line on the treatment graph
- they present 8-24hrs after ingestion of >150mg/kg
- they present >24hrs after ingestion and have clear jaundice or if they have hepatic tenderness, raised ALT above upper limit of normal, an INR >1.3 or a paracetamol conc is detectable
What dose of paracetamol is considered high risk of toxicity in an overdose ?
More than 150 mg/kg
75-150 mg/kg is rarely toxic, and less than 75 is very unlikely
What does ‘therapeutic excess’ of paracetamol mean ?
When the dose of paracetamol ingested is potentially toxic, but with no intent of self harm
e.g in order to try treat pain etc
When should someone be referred to a hospital, regarding potential paracetamol overdose ?
- if symptomatic (jaundice etc)
- if ingested 75 mg/kg or more within 24hrs
- if ingested more than listed dose, but less than 75 mg/kg/24hrs on both the preceding 2+ days
What is considered a ‘staggered dose’ when referring to a paracetamol overdose ?
Staggered dose = a potentially toxic dose taken over the span of more than 1hr with the intention of self harm
What is the treatment for patients who have had a paracetamol overdose via a staggered dose timeframe ?
Immediately treat them with acetylcysteine
When is a liver transplant indicated following a paracetamol overdose ?
- arterial pH <7.3 or lactate >3 after fluid resus, OR
- if all of the following occur in a 24hr period…
— creatinine >300 micromol/L
— PT >100secs (INR >6.6)
— grade 3/4 encephalopathy
When does toxicity usually peak after a paracetamol overdose ?
48-72 hrs after ingestion
