Overdoses

Question 1

Paracetamol
-risk factors for hepatotoxicity

Answer 1

Liver enzyme inducers - CRAPGPS
Malnourished, no oral intake for few days
CHRONIC ALCOHOL, not acute

Question 2

Management
-presentation within 1hr
-use of NAC
-how to infuse

Answer 2

Present within 1hr - activated charcoal

NAC
-4hrs post => [plasma paracetamol] above treatment line
-unclear time of ingestion or staggered (not all taken within 1hr)
-8-24hrs post ingestion of 150mg/kg+
-24hrs+ and jaundiced/hepatic tenderness/ALT upper limit of normal

If continuing high [serum paracetamol] or ALT => continue NAC

1hr infusion
-reduce anaphylactoid reaction

Question 3

KCH criteria for liver tranplantation

Answer 3

pH U7.3 24hrs after ingestion
OR
All 3 of
-PT 100s+
-creatinine 300+
-grade 3, 4 encephalopathy

Question 4

Salicylate
-presentation
-investigations
-management

Answer 4

Hyperventilation => respiratory alk
Tinnitus, tired
Sweating, fever
N/V
Hyper/hypoglycemia
Seizures
Coma

ABG - resp alk => met acid

Resus, charcoal within 1hr
IV Na2HCO3

Hemodialysis if
-treatment resistance met acid
-pulmonary edema
-seizures, coma
-serum conc 700+