Paracetamol Management

what is max dose

in 24 hours 4g

what is acute iverdose

excessive ingested over a small period of time

usually self harm

what is staggered overdose

excessive ingestion over 1 hour so if they take it over the day for pain

also can be intent of self harm

how likely is risk

>150mg in 24 hours serious

>75mg/kg likely

<75mg/kg unlikely

what is glutathione deficiency

higher risk of liver damage when taking paracetamol

binds to metabolite of paractemaaol which is excreted so of this doesnt happn it is damaged

What is cytochrome P450 inducers

water meds affect enzymes reduced in liver so can increases liver injury

what are the signs of excess

first 24 hours - nausea and vomiting and general adominal pain

after -

jaundice - liver injury

hepalomegaly

reduced GCS

RUQ pain

how is the damage measured

damage is directly proportional to amount taken but factors affect the damage

who is referred to hospital

symptomatic pts

pt who have taken more than 75mg/kg AND more thsn licensed dose

ingested more than licensed daily dose but less than 75mg/kg preceeding more than 2 days

how do we treat paracetamol excess

acetylcysteine - invreases hepatic glutathione

given within 8 hours of ingestion is almost 100% effective

given in 2 IV infusions

who is at risk of glutathione deficiency

eating disorder

malnourishment

chronic diseases - HIV cystic fibrosis

alcohol disorder

what drugs increase risk of liver injury in paracetamol overdose

antiepileptics

barbiturates

antibiotics

anri retrovirals

st john worts