Management of Paracetamol (Acetaminophen) Poisoning

February 07, 2025

Paracetamol (acetaminophen) overdose is one of the most common causes of drug poisoning worldwide. It can lead to severe liver failure (acute hepatotoxicity) if not treated promptly. Early intervention is critical! 🚑

🔍 Causes of Paracetamol Poisoning

Paracetamol poisoning occurs due to:
🔸 Accidental overdose (common in children & elderly) 👶👴
🔸 Intentional overdose (suicide attempts) 😢
🔸 Chronic excessive use (long-term use exceeding safe doses) 💊
🔸 Drug interactions (alcohol, enzyme inducers like rifampin) 🍷💉
🔸 Liver disease (higher susceptibility to toxicity) 🏥

✅ Toxic Dose of Paracetamol
🔹 Adults: > 7.5 g in 24 hours
🔹 Children: > 150 mg/kg in 24 hours

⚠ Symptoms of Paracetamol Poisoning

Symptoms appear in four stages:

🔴 Stage 1 (0-24 hours) – Early Phase

✔ Nausea & vomiting 🤢
✔ Abdominal pain 🩺
✔ Loss of appetite 🚫🍽
✔ Fatigue & sweating 😓

🟠 Stage 2 (24-72 hours) – Hepatic Injury

✔ Liver enlargement & tenderness 🫀
✔ Right upper quadrant pain 🤕
✔ Elevated liver enzymes (ALT, AST) 📊

🟡 Stage 3 (72-96 hours) – Liver Failure (Maximum Toxicity)

✔ Jaundice (yellow skin/eyes) 🟡
✔ Confusion & altered mental status 🧠
✔ Bleeding tendencies (coagulopathy) 🩸
✔ Multi-organ failure 🚑

⚫ Stage 4 (4-14 days) – Recovery or Death

✔ If untreated, leads to liver failure, coma, & death ☠️
✔ If treated early, full recovery is possible 🏥

🩺 Diagnosis of Paracetamol Poisoning

✅ Serum Paracetamol Level (4 hours after ingestion) 🩸
✅ Liver Function Tests (LFTs) – ALT, AST, Bilirubin 📊
✅ INR/PT (Coagulation tests) 🩸
✅ Blood glucose & renal function 🏥

📌 Use the Rumack-Matthew Nomogram 📉
🔹 Helps determine toxicity risk based on serum paracetamol level & time since ingestion

⚕️ Treatment of Paracetamol Poisoning

1️⃣ Activated Charcoal (Within 1-2 Hours) ⚫

🔹 Dose: 1g/kg (Max: 50g)
🔹 Only effective if given within 1-2 hours of overdose

2️⃣ N-Acetylcysteine (NAC) – Antidote! 💉

✅ Best if started within 8 hours (Reduces hepatotoxicity)
✅ Can be given IV or Oral

📌 IV NAC Protocol (21 hours)
🔹 Loading dose: 150 mg/kg over 1 hour
🔹 Next: 50 mg/kg over 4 hours
🔹 Final: 100 mg/kg over 16 hours

📌 Oral NAC Protocol (72 hours)
🔹 140 mg/kg loading dose
🔹 70 mg/kg every 4 hours for 17 doses

🚨 If liver failure develops:
✅ Supportive care – Fluids, glucose, vitamin K, plasma transfusion
✅ Liver transplant for severe cases 🏥

🛑 When to Admit the Patient?

🏥 Admit to ICU if:
✔ Severe hepatotoxicity (INR > 3, AST/ALT > 1000)
✔ Altered mental status or encephalopathy 🧠
✔ Metabolic acidosis (pH < 7.3) 🩸
✔ Multi-organ failure 🚑

💡 Prevention of Paracetamol Poisoning

✅ Follow recommended doses (Max: 4g/day in adults) 📋
✅ Avoid self-medication & high doses ❌💊
✅ Monitor liver function in chronic users 📊
✅ Educate patients on toxicity risks 🏥
✅ Keep medications away from children 👶🚫

🔚 Conclusion

Paracetamol poisoning is life-threatening but treatable if detected early. N-Acetylcysteine (NAC) is the antidote, and timely intervention can prevent liver failure. Public awareness & responsible medication use are crucial!

⚠ Disclaimer

This article is for informational purposes only and is not a substitute for professional medical advice. Always consult a healthcare provider in case of poisoning.

📢 Hashtags

#ParacetamolPoisoning #Toxicology #DrugOverdose #EmergencyMedicine #LiverFailure #PoisonControl #MedicalEducation #InternalMedicine #DrMuhammadIsmail #DMI #GlobalHealth

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