ACETAMINOPHEN OVERDOSE HARIKRISHNA SHEEJA GROUP#612

Paracetamol Overdose

MOST COMMON

FEW SYMPTOM

S12g

FATAL

Characteristics of Acetaminophen

White solid crystals Lightly soluble in cold water Greater solubility in hot water Solubility in organic solvents Soluble in menthol

Acetaminophen’s Pharmaceutical Classes

Derivative of acetanilide Analgesic Non-narcotic Antipyretic

Metabolism

Clinical picture

After 72-96hrs of ingestion

Minimum toxic doses for a single ingestion, posing significant risk of severe hepatotoxicity:

Adults: 7.5-10 gChildren: 150 mg/kg; 200 mg/kg in healthy children aged 1-6 years

Serum Acetaminophen Levels

Rumack-Matthew nomogram

Diagnosis

PCM LEVELS BLOOD &URINE

TOXICOLOGY SCREEN

MANAGEMENT

• EMPTY STOMACH TAKEN WITHIN 1 HOUR

• If < 8 hours :Tx of choice – activated charcoal 1g/kg

If 8-24 hours & suspicious of large overdose (> 7.5g )

If Unknown Time of overdose

Determine serum acetaminophen levels

Determine INR levels, LFT

Treat with Acetylcysteine if serum Acetaminophen or transaminases (ALT, AST) are detected

Patient should not take over 4 grams of Acetaminophen/day.

Threshold may be lower for patients with liver disease or cirrhosis

Increased risk of hepatotoxicity with chronic alcohol use

Patient should be careful when taking numerous products containing Acetaminophen

Reference

http://bestpractice.bmj.com/best-practice/monograph/337/basics/pathophysiology.html

http://emedicine.medscape.com/article/820200-overview http://

www.nhs.uk/Conditions/Poisoning/Pages/Symptoms.aspxSarawak Handbook of Medical Emergencies 3rd EditionOxford Handbook of Clinical Medicine 6th Ed.