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Paracetamol poisoning
- 1. PARACETAMOL POISONING DR.MANOJ MD MEDICINE https://youtu.be/s8mcVGYny68
- 2. PARACETAMOL POISONING 1.METABOLISM 2.TOXIC DOSAGE 3.CLINICAL FEATURES 4.MANAGEMENT
- 3. MECHANISM • Metabolised in 2 phases NAPQI MERCAPTURIC ACID PCM PHASE 1 PHASE 2
- 5. • THERAPEUTIC DOSE – 15MG/KG • AT DOSES >140mg/kg the sulfate and gluconate pathway get saturated.
- 6. NAPQI MERCAPTURIC ACID PCM HARMLESS -oxidative hepatocyte injury, -alteration of the mitochondrial ATPsynthase α- subunit, and -hepatocellular centrilobular necrosis.
- 7. High risk people: -1.Conditions of CYP induction (e.g. heavy alcohol consumption, those on anticonvulsant drugs) -2.Condition of GSH depletion (e.g. fasting or malnutrition) -3.With pre-existing liver disease.
- 8. TOXIC DOSE • SINGLE DOSE - > 7 TO 10G • FATAL DOSE > 15 TO 25G • HEAVY DRINKERS > 2TO 6 G • USUAL TOXIC DOSE - >150MG/KG • THERAPEUTIC DOSE – 15MG/KG
- 9. STAGES Stage 1 Stage 2 Stage 3 Stage 4 LESS THAN 24HOUR - Non specific symptom - Asymtomatic - Lab studies- normal 24 TO 72 HOUR : -Enzymes start raising -AKI ,pancreatitis 72 TO 96 HOURS - Severe hepatoxicity - Death most common - HEPATIC STAGE 4 DAYS TO 2 WEEKS - RECOVERY PHASE - Gradually improves
- 10. AKI Renal impairment - less than 2 percent. AKI is due primarily - ATN. Usually spontaneously improves. NAC wont affect – kidney prognosis
- 11. INDICATORS OF POOR PROGNOSIS • HEPATIC COMA • ACIDOSIS PH<7.3 • PT PROLONGATION • CREATNINE RAISE >3.3 • FALLING ALT WITH WORSENING PT
- 12. MANAGEMENT • Activated charcoal, 1 g/kg (maximum dose 50 g) by mouth in all patients who present within four hours.
- 13. • N-acetylcysteine - all patients who r at significant risk for hepatotoxicity. • Start therapy before the onset of (ALT) elevation. • This is accomplished by initiating treatment within 8 hours of an acute ingestion.
- 16. N-ACETYLCYSTENINE 20 HOUR IV-PROTOCOL 70 HOUR ORAL PROTOCOL
- 17. 20 HOUR IV-PROTOCOL -150MG/KG IV BOLUS IN 1HOUR -12.5 MG/KG /HOUR * 4 HOUR -6.25MG/KG/HOUR*16 HOUR 70 HOUR ORAL-PROTOCOL -140MG/KG LOADING DOSE -70MG/KG EVERY 4 HOUR TILL 17 DOSES
- 18. PREGNANCY
- 19. OTHER METHODS • METHIONINE • DIALYSIS
- 20. SUMMARY • NAPQI – MAIN TOXIC PRODUCT RESPONSIBLE • C.F IN FOUR STAGES • TOXIC DOSE- >150MG/KG • MODIFIED RUMACK MATHEW NOMOGRAM • N-ACETYLCYSTINE – 20 HR IV PROTOCOL AND 70 HOUR ORAL PROTOCOL. THANK YOU …. .bmpinternalmedicine@gmail.com
Editor's Notes
- SIRS has been something that has been beat into our heads as medical students. The derivation occurred in the year 1991 when the focus was on the hosts inflammatory response. Another task force constituted in the year 2001 recognized the limitations but really did not offer any alternatives. So what we have been left with is the sepsis definition largly unchanged for more than 2 decades.