Paracetamol overdose Flashcards
What is paracetamol the most common agent of?
Most common agent for intentional self-harm in the UK.
What is paracetamol also knwon as?
Acetaminophen
How can a paracetamol overdose present?
Asymptomatic
What are the possible symptoms of a paracetamol overdose?
Nausea and vomiting
Loin pain
Haematuria and proteinuria
Jaundice
Abdominal pain
What is the more severe presentation of a paracetamol overdose?
Coma
What type of blood gas does a paracetamol overdose present with?
Severe metabolic acidosis
What does a paracetamol overdose result in a build up of?
NAPQI
What is the management of a patient who presents within 1 hour?
Activated charcoal
What is the management of a paracetamol overdose If staggered overdose or ingestion >15 hours ago?
Start N-acetylcysteine immediately
What is the management of a paracetamol overdose if ingestion <4 hours ago?
Wait until 4 hours to take a level and treat with N-acetylcysteine based on level
What is the management of a paracetamol overdose If ingestion 4-15 hours ago?
Take immediate level and treat based on level
What adverse effect can Aceytlcysteine cause?
Acetylcysteine commonly causes an anaphylactoid reaction (non-IgE mediated mast cell release).
How can anaphylactoid reactions be managed?
By stopping the infusion, then restarting at a slower rate
Which patients have an increased risk of toxicity from a paracetamol overdose?
Patient on long-term enzyme inducers
Regular alcohol excess
Pre-existing liver disease
Glutathione-deplete states: eating disorders, malnutrition and HIV.
What is the decision to treat a paracetamol overdose based on?
Deciding whether to treat is based on a nomogram
If paracetamol levels are above the treatment line then start NAC.
