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Paracetamol overdose
- Single ingestion of 10g may cause liver failure
- in susceptible individual doses as low as 6 g can kill.
- Increased risk of toxicity if:
- HIV positive
- malnourished
- regular abuser of alcohol,
- phenytoin,
- carbamazepine
Clinical presentation:
- 0-24 hours: asymptomatic; may be some vomiting
- 24-36 hours: right upper quadrant pain and vomiting
- 36-72 hours: jaundice, retching, and liver failure
- 72-120 hours: liver and renal failure
Markers of severe poisoning:
- More than 150mg/kg ingested
- Vomiting within a few hours of ingestion
- Abdominal pain on presentation
- Prolonged INR
- Abnormal LFTs within 12 hours
- Dramatic AST or ALT rise to >10,000
- hyperbilirubinaemia
Management:
- If presentation is less than one hour, give 50g of activated charcoal.
- If presentation within 4 hours, start NAC if large overdose of high risk.
Stop if 4-hour level below treatment line.
- If presentation within 16 hours, give NAC according to treatment lines.
- More than 24 hours, give NAC to all severe or high risk overdoses
Consult with the liver unit early in severe overdose where transplantation is
a possibility.
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