Pcm Toxicity

Question 1

What is the Rumack Mathew line for acetaminophen overdose?

Answer 1

If the values are at least 100 Hg/mL at 8 hours and 200 Hg/mL at 4 hours: do an orthoptic liver transplant.

If the values are lower than this: N-acetylcysteine is given.

Question 2

What does the grey area in the acetaminophen nomogram indicate?

Answer 2

The area in grey denotes that we have to do an intervention.

Question 3

What is the treatment line threshold compared to the Rumack Mathew line?

Answer 3

The treatment line threshold is kept 25% lower than the Rumack Mathew line.

Question 4

What is required if a person falls to the left side of the treatment line?

Answer 4

Only conservative treatment is required.

Question 5

What is the safe dose of paracetamol for the general population?

Answer 5

3 grams per day.

Question 6

What is the safe dose of paracetamol for alcoholic patients?

Answer 6

2 grams per day.

Question 7

What is the risk associated with PCM in combination with opioid tablets?

Answer 7

There is a risk of causing paracetamol toxicity due to dependence.

Question 8

What is the maximum marketed dose of PCM to decrease the risk of toxicity?

Answer 8

325 mg tablet.

Question 9

What daily dose of acetaminophen requires hospitalization?

Answer 9

10 - 15 grams per day.

Question 10

What daily dose of acetaminophen has higher chances of fatality?

Answer 10

> 25 grams per day.

Question 11

What is the antidote for acetaminophen overdose?

Answer 11

N-acetyl cysteine.

Question 12

When should N-acetylcysteine be started in a patient?

Answer 12

If indicated, start within 8 hours of intake and can be given up to 24-36 hours.

There is a reduction in mortality.

Question 13

What blood PCM level at 4 hours of ingestion indicates a high chance of liver damage?

Answer 13

Blood PCM >300 pg/ml.

Question 14

What blood PCM level at 4 hours of ingestion indicates that damage is unlikely?

Answer 14

Blood PCM < 150 ug/ml.

Question 15

How is PCM metabolized?

Answer 15

Metabolized by phases 1 and 2 of metabolism.

Question 16

What occurs in Phase 1 of PCM metabolism?

Answer 16

Cytochrome P450 produces NAPQ 1 (N-acetyl-P-benzoquinone Imine) neutralized by Glutathione.

Question 17

What are the effects of low glutathione levels?

Answer 17

In alcoholics, starvation, consumption of anti-TB drugs (INH), and Barbiturates, it can cause more damage to the liver.

Question 18

What does N-acetyl cysteine do?

Answer 18

Generates glutathione.

Question 19

What occurs in Phase 2 of PCM metabolism?

Answer 19

Involves conjugation, responsible for sulfate moiety and glucuronidation.

Question 20

What are the clinical features at 4-12 hours post PCM ingestion?

Answer 20

Nausea, vomiting, diarrhea, abdominal pain, and shock.

Question 21

What are the clinical features at 24-48 hours post PCM ingestion?

Answer 21

Fulminant hepatic failure, coagulopathy, and encephalopathy.

Question 22

What are signs of acute kidney injury from PCM?

Answer 22

Oliguria or anuria.

Question 23

What indicates myocardial injury in PCM toxicity?

Answer 23

Elevated troponins.

Question 24

What is the first treatment for PCM overdose?

Answer 24

Gastric lavage (not effective after half an hour of intake).

Question 25

What is another treatment option for PCM overdose?

Answer 25

Cholestyramine.

Question 26

What is the antidote for PCM if administered within 8 hours?

Answer 26

N-Acetylcysteine. ## Footnote MOA: replenish levels of glutathione which will neutralize NAPQ 1, by providing sulfhydryl groups to glutathione.

Question 27

What is the treatment if fulminant hepatic failure is present?

Answer 27

An orthoptic liver transplant is done.

Question 28

What is the leading cause of poisoning in children less than 6 years?

Answer 28

Iron toxicity.

Question 29

What are the stages of iron toxicity?

Answer 29

Stage 1: Nausea, vomiting, hemorrhagic manifestations, diarrhea, and shock. Stage 2: Latent phase, patient appears relatively better. Stage 3: Metabolic acidosis causes cardiac depression. Stage 4: Damage to the liver.

Question 30

What is the most common cause of death from iron toxicity?

Answer 30

Metabolic acidosis.

Question 31

What is coagulopathy?

Answer 31

A condition affecting the blood's ability to coagulate.

Question 32

What is encephalopathy?

Answer 32

A broad term for any brain disease that alters brain function or structure.

Question 33

What occurs in Stage-5 (Delayed phase) of the condition?

Answer 33

Scarring of the gut.

Question 34

What complication do patients face due to the condition?

Answer 34

Gastric outlet obstruction.

Question 35

What is the management for the condition?

Answer 35

I.V. fluids and oxygen supplementation.

Question 36

What is the role of activated charcoal and ipecac in this condition?

Answer 36

There is no role for activated charcoal and ipecac.

Question 37

What is deferoxamine used for?

Answer 37

To chelate the iron.

Question 38

What are the indications for deferoxamine?

Answer 38

> 350 pg/dl: toxicity > 500 ug/dl: irrespective of toxicity

Question 39

What is deferasirox used for?

Answer 39

Used in chronic overload and >2-year thalassemia transfusion dependent.

Question 40

What is a condition associated with chronic overload?

Answer 40

Primary bronze diabetes.