Paracetamol Poisoning and Renal Function Assessment

This set covers the clinical history, risk assessment, symptoms, investigations, and management protocols for paracetamol poisoning, including renal and liver function evaluations.

Initial open-ended question for history taking

"Can you tell me what has happened so far?"

Hepatotoxicity risk factors

Alcohol, drugs, seizure medications, St. John's worth, herbal medications, recent fasting, or previous history of liver disease.

Symptoms of paracetamol toxicity

Nausea, vomiting, abdominal pain, sweating, dizziness, or confusion.

Psychological evaluation questions

Assessment of previous history of suicide or self-harm, mood before the incident, and stressors at home, work, or university.

Female-specific clinical questions

Questions regarding the last menstrual period or potential pregnancy.

Liver function test (LFT) enzymes

$AST$ and $ALT$.

Coagulation study parameters

$PT$ and $INR$.

Renal function test (RFT) components

Urea, electrolytes, creatinine, and $eGFR$.

Standard investigations for paracetamol poisoning

Serum paracetamol level, LFT, coagulation study, full blood examination, renal function test, $ECG$, blood sugar level, and venous blood gases.

Activated charcoal

Management intervention performed if the time of ingestion is less than $2$ to $4$ hours.

Non acetylcholine

Treatment considered if ingestion is more than $4$ hours ago or if the serum paracetamol concentration is above the treatment line on charts.

Treatment threshold

The treatment line on serum paracetamol concentration charts used to determine if the patient should receive non acetylcholine.