in this we discuss about how acetaminophen effect our body and show their toxicity when used in large amounts

1. Acetaminophen
poisoning
PRESENTED BY :
*Pauline. Ravela
SIMS College Of
Pharmacy

2. HISTORY
Synthesized in 1877 in U.S.
Extensive use began around 1947
Initially prescription only in the U.S.
Otc status gained in 1960
Toxic effects first noted in U.S. in 1971

3. ACTIONS
• ANALGESIA
Relieves mild to
moderate pain.
Efficacy equivalent to
salicylates .
Inhibits brain
prostaglandin synthesis.
Blocks pain impulse
peripherally.
• ANTIPYRESIS
Efficacy similar to
salicylates .
Inhibits prostaglandin
synthesis in the
hypothalamus .

4. • In overdose situation , liver enzymes become
saturated , glutathione is depleted , NAPQI [ N
– acetyl – p- benzoquinoneimine]
accumulates & hepatic necrosis occurs.

5. PHARMACOKINETIC’S
• Absorption:
Rapidly absorbed from GI tract.
• Distribution:
approx.20% plasma protein bound
may increase to 50% in overdose.
• Metabolism:
1. 52% by sulfation
2. 42% by glucuronidation
3. 2% by excreted unchanged in the
urine
4. 4% by biotransformed by C-
P450 MFO system
• Excretion :kidneys
• T1/2 : 0.9 – 3.25 hours
• Potential liver damage
Adults - > 150 mg/kg
Adults - > 7.5 grams in 24hrs
( chronic )
Children ( 10yrs ) : > 200mg/kg

6. TOXICITY
Factors involved in predicting hepatotoxicity
Total quantity ingested
alcoholism
Time from ingestion to treatment
Age of the patient
Enzyme inducing medications
Serum concentration in relation to Rumack
Nomogram

7. TYPES OF OVERDOSE
ACUTE CHRONIC
A toxic dose ingested in <8hrs
RUMACK NOMOGRAM IS
USEFUL
A toxic dose ingested in >8hrs
RUMACK NOMOGRAM IS
NOT USED
TOXIC DOSE 150MG/KG

8. STAGES OF ACETAMINOPHEN
POISOINING

12. DIAGNOSIS

13. TREATMENT

14. Acetaminophen causing Autism
• In the study July 6 , 2016 Spanish researchers questioned 2,644 women about their
use of paracetamol (acetaminophen) during pregnancy and, when they assessed
their children at age five, found that children exposed to the drug in utero were at a
30 percent higher risk of hyperactivity and impulsive behaviour. They also
found an increase in two clinical symptoms of autism in boys whose mothers
regularly took the painkiller.
• All pregnant women should seek medical advice before taking any medications, but
for most mothers-to-be, acetaminophen use is deemed safe. A 2010 study from the
Centers for Disease Control and Prevention (CDC) found no increased risk of
major birth defects with use of acetaminophen in the first trimester of
pregnancy, and some studies have even suggested it may lower the risk of birth
defects.

15. • Shaw recently presented compelling evidence in 2015
october that acetaminophen (Tylenol) depletes
glutathione in autism, asthma, and other disorders:
“The characteristic loss of Purkinje cells in the brains
of people with autism is consistent with depletion of
brain glutathione due to excess acetaminophen usage,
which leads to premature brain Purkinje cell death

16. • Also known as paracetamol,
acetaminophen is one of
the most commonly used
over-the-counter
medications during
pregnancy. Around65
percent of expectant
mothers in the United
States use the drug.
• However, there has been
some evidence that
acetaminophen use during
pregnancy may interfere
with the brain development
of offspring. In 2014, a
study published in JAMA
Pediatrics found that
expectant mothers who
used acetaminophen were
more likely to have children
with behaviours associated
with attention deficit
hyperactivity disorder
(ADHD).

17. ACETAMINOPHEN CAUSING
ASTHMA
• Exposure to acetaminophen before birth and in infancy is
linked to developing asthma in childhood, confirms a new
study that also finds the link is independent of the reason for
medication use.
• The team found that 5.7% of the children had
asthma at age 3, and 5.1% had it at age 7.

18. After a recent review of pain medication use in pregnancy - including
acetaminophen - the Food and Drug Administration (FDA) did not
change their advice that pregnant women "should always consult with
their health care professional before taking any prescription or OTC
[over the counter] medicine."
Acetaminophen is an active ingredient in hundreds of OTC and
prescription medicines, and it is also combined with other active
ingredients in medicines that treat allergy, cough, colds, flu and
sleeplessness.

20. REFERENCES
• Acetaminophen poisoning : an update for the
intensivist by Paul / Dargan and Alison L Jones.
• Acetaminophen toxicity management and
Treatment by Susan E Farrell , MD.
• Acetaminophen overdose by Josephine s ,
National council on patient information and
education (NCPIE)