This document provides an overview of paracetamol (acetaminophen) including its history, epidemiology, pathophysiology, clinical presentation, management, and N-Acetyl Cysteine (NAC) treatment protocol for overdose. It describes paracetamol as a commonly involved drug in overdose cases that can cause severe liver damage if taken in high enough quantities. The management of paracetamol overdose involves evaluation to determine risk of hepatotoxicity and administration of NAC, an antidote, to prevent liver injury.
Paracetamol was developed in the late 1880s as a less toxic derivative of acetanilide. It is metabolized in the liver to a toxic intermediate called NAPQI, which is normally detoxified by glutathione. An overdose can deplete glutathione stores, allowing NAPQI to damage liver cells. Paracetamol poisoning has few early symptoms but can cause liver failure and death. Treatment involves N-acetylcysteine to replenish glutathione within 8-24 hours of ingestion. Prognosis depends on factors like time to treatment, dose ingested, and underlying liver health.
This document provides guidance on the management of paracetamol poisoning. It discusses the hepatotoxicity threshold, time window for administering N-acetylcysteine to be effective, and clinical phases of toxicity. It also outlines criteria for transferring patients to a liver unit and tips for managing overdoses, including using nomograms to determine treatment and monitoring extended release preparations. Risks are generally low if NAC is started within 8 hours of ingestion.
This document discusses paracetamol (acetaminophen) poisoning. It covers the introduction, metabolism, mechanism of toxicity, clinical features, diagnosis, management, postmortem findings, and medicolegal importance of paracetamol poisoning. Paracetamol is metabolized in the liver and can cause toxicity when levels of its toxic metabolite NAPQI exceed levels of glutathione in the liver, leading to liver and sometimes kidney damage. Management involves gastric decontamination and use of the antidote N-acetylcysteine to prevent binding of NAPQI if administered early. Fulminant liver failure may require liver transplantation.
Medical emergency on paracetamol poisoningIndhu Reddy
This document provides information on paracetamol (acetaminophen) poisoning, including its introduction, mechanisms of action, toxicity, clinical features, investigations, management, and antidote. It discusses that paracetamol is metabolized to a toxic metabolite that can cause liver damage if glutathione levels are depleted. Patients presenting with elevated liver enzymes and international normalized ratio following ingestion should receive N-acetylcysteine to replenish glutathione levels based on standardized treatment protocols. Timely administration of N-acetylcysteine within 10 hours of ingestion can prevent liver injury from paracetamol poisoning.
A 35-year-old Indian housewife presented to the hospital 2 hours after intentionally ingesting 20 tablets of paracetamol (acetaminophen) due to family problems and suicidal thoughts. Her physical exam was unremarkable except for tachycardia. Laboratory tests and management for paracetamol overdose were recommended based on the risk of liver toxicity and failure from metabolism of excess amounts into a reactive compound depleted by glutathione stores. Treatment with N-acetylcysteine was indicated based on the timing and amount of ingestion to prevent hepatotoxicity.
1) The document provides an overview of paracetamol (acetaminophen), including its history, pharmacokinetics, mechanism of action, toxicity, diagnosis, treatment, and prognosis.
2) It describes paracetamol's absorption in the small intestine, metabolism primarily in the liver, and excretion mainly through the kidneys. Toxicity can occur when a toxic metabolite, NAPQI, is formed and not detoxified.
3) Treatment for paracetamol overdose involves gastric decontamination, administration of the antidote N-acetylcysteine to replenish glutathione levels and prevent liver damage, and potentially hemodialysis or liver transplant for
Acetaminophen overdose is the most common cause of drug-induced liver failure. Symptoms of an overdose may not appear for 24 hours after ingestion of 12 grams or more. Acetaminophen is metabolized in the liver and an overdose can cause liver toxicity. Treatment depends on the time since ingestion and amount taken, and may involve administering activated charcoal or acetylcysteine to prevent liver damage. The threshold for potential liver toxicity is lower for those with liver disease or who consume alcohol regularly.
Paracetamol is a commonly used analgesic and antipyretic that is well absorbed orally. At normal doses, it is metabolized through conjugation pathways and excreted in urine. However, in overdose the conjugation pathways become saturated and it is metabolized through the toxic NAPQI pathway. This can lead to glutathione depletion and liver injury. N-acetylcysteine is the antidote and works best if given within 10 hours of overdose to replenish glutathione levels before liver damage occurs. Symptoms of overdose include nausea, vomiting and liver damage signs like jaundice and coagulopathy.
Paracetamol was developed in the late 1880s as a less toxic derivative of acetanilide. It is metabolized in the liver to a toxic intermediate called NAPQI, which is normally detoxified by glutathione. An overdose can deplete glutathione stores, allowing NAPQI to damage liver cells. Paracetamol poisoning has few early symptoms but can cause liver failure and death. Treatment involves N-acetylcysteine to replenish glutathione within 8-24 hours of ingestion. Prognosis depends on factors like time to treatment, dose ingested, and underlying liver health.
This document provides guidance on the management of paracetamol poisoning. It discusses the hepatotoxicity threshold, time window for administering N-acetylcysteine to be effective, and clinical phases of toxicity. It also outlines criteria for transferring patients to a liver unit and tips for managing overdoses, including using nomograms to determine treatment and monitoring extended release preparations. Risks are generally low if NAC is started within 8 hours of ingestion.
This document discusses paracetamol (acetaminophen) poisoning. It covers the introduction, metabolism, mechanism of toxicity, clinical features, diagnosis, management, postmortem findings, and medicolegal importance of paracetamol poisoning. Paracetamol is metabolized in the liver and can cause toxicity when levels of its toxic metabolite NAPQI exceed levels of glutathione in the liver, leading to liver and sometimes kidney damage. Management involves gastric decontamination and use of the antidote N-acetylcysteine to prevent binding of NAPQI if administered early. Fulminant liver failure may require liver transplantation.
Medical emergency on paracetamol poisoningIndhu Reddy
This document provides information on paracetamol (acetaminophen) poisoning, including its introduction, mechanisms of action, toxicity, clinical features, investigations, management, and antidote. It discusses that paracetamol is metabolized to a toxic metabolite that can cause liver damage if glutathione levels are depleted. Patients presenting with elevated liver enzymes and international normalized ratio following ingestion should receive N-acetylcysteine to replenish glutathione levels based on standardized treatment protocols. Timely administration of N-acetylcysteine within 10 hours of ingestion can prevent liver injury from paracetamol poisoning.
A 35-year-old Indian housewife presented to the hospital 2 hours after intentionally ingesting 20 tablets of paracetamol (acetaminophen) due to family problems and suicidal thoughts. Her physical exam was unremarkable except for tachycardia. Laboratory tests and management for paracetamol overdose were recommended based on the risk of liver toxicity and failure from metabolism of excess amounts into a reactive compound depleted by glutathione stores. Treatment with N-acetylcysteine was indicated based on the timing and amount of ingestion to prevent hepatotoxicity.
1) The document provides an overview of paracetamol (acetaminophen), including its history, pharmacokinetics, mechanism of action, toxicity, diagnosis, treatment, and prognosis.
2) It describes paracetamol's absorption in the small intestine, metabolism primarily in the liver, and excretion mainly through the kidneys. Toxicity can occur when a toxic metabolite, NAPQI, is formed and not detoxified.
3) Treatment for paracetamol overdose involves gastric decontamination, administration of the antidote N-acetylcysteine to replenish glutathione levels and prevent liver damage, and potentially hemodialysis or liver transplant for
Acetaminophen overdose is the most common cause of drug-induced liver failure. Symptoms of an overdose may not appear for 24 hours after ingestion of 12 grams or more. Acetaminophen is metabolized in the liver and an overdose can cause liver toxicity. Treatment depends on the time since ingestion and amount taken, and may involve administering activated charcoal or acetylcysteine to prevent liver damage. The threshold for potential liver toxicity is lower for those with liver disease or who consume alcohol regularly.
Paracetamol is a commonly used analgesic and antipyretic that is well absorbed orally. At normal doses, it is metabolized through conjugation pathways and excreted in urine. However, in overdose the conjugation pathways become saturated and it is metabolized through the toxic NAPQI pathway. This can lead to glutathione depletion and liver injury. N-acetylcysteine is the antidote and works best if given within 10 hours of overdose to replenish glutathione levels before liver damage occurs. Symptoms of overdose include nausea, vomiting and liver damage signs like jaundice and coagulopathy.
this presentation is about the acetaminophen or paracetamol as its second name and its overdose reactions and activities. and its toxic effects that may be harmful and cause damages in the people.
This document discusses hypertension in pregnancy, including classifications, diagnostic criteria, risk factors, pathophysiology, prevention, and management. It classifies hypertensive disorders in pregnancy into four categories: gestational hypertension, preeclampsia, chronic hypertension, and chronic hypertension with superimposed preeclampsia. It provides diagnostic criteria for each condition and indicators of severity. Risk factors include young maternal age, obesity, multifetal gestation, and genetic predispositions. The pathophysiology involves abnormal placental invasion and maternal inflammatory response. Management depends on severity of features and gestational age, ranging from expectant monitoring to expedited delivery.
This presentation discusses paracetamol toxicity and provides information on its definition, history of use, therapeutic uses, toxicokinetics, mechanisms of toxicity, clinical features of acute and chronic overdose, diagnosis, and treatment including use of activated charcoal, N-acetylcysteine, methionine, and liver transplantation in severe cases. Key points covered include paracetamol's mechanism of hepatotoxicity through production of the reactive intermediate NAPQI, signs of liver damage that present 2-3 days after overdose, and the importance of administering N-acetylcysteine within 10 hours of ingestion to prevent liver injury.
The document discusses acetaminophen poisoning in children. It describes acetaminophen as a drug with analgesic and antipyretic properties that can cause toxicity when too much is ingested. The toxicity results from a reactive metabolite that depletes glutathione stores in the liver. It outlines the stages of acetaminophen toxicity and emphasizes the importance of rapid treatment with N-acetylcysteine to prevent liver damage. Diagnosis involves measuring acetaminophen levels in conjunction with liver enzymes and coagulation factors.
Propranolol is the most common beta-blocker involved in severe beta-blocker poisoning. It is nonselective and can lead to CNS depression, seizures, and prolongation of the QRS complex.
Beta blocker toxicity is notably distinguished by bradycardia, low respiratory
rate and hypoglycemia
Seizures and other CNS effects can occur with beta blockers that can cross the blood brain barrier (more rarely with the other beta blockers)
Overdoses of beta blockers with a combination of other drugs can have wide
ranging systemic effects
If within a short time after ingestion, give activated charcoal
Treat with glucagon to raise blood glucose levels
Widely used treatment is currently Atropine though it is considered less effective
Treat bronchospasm with beta agonists like Albuterol
Treat Seizures with Benzodiazepines like Valium
If the patient is still unresponsive or the condition is still deteriorating, treat with epinephrine
Management of hyperkalemia dakahlia medical syndicate 2o18FAARRAG
This document discusses hyperkalemia (high potassium levels), including its definition, classification, causes, and approach to assessment and management. Some key points:
- Hyperkalemia is defined as a serum potassium level above 5.0-5.5 mEq/L in adults and can be mild (5.5-6.0 mEq/L), moderate (6.1-7.0 mEq/L), or severe (≥7.0 mEq/L). Levels over 7-8.5 mEq/L can cause cardiac issues.
- Causes include reduced renal excretion, shifts of potassium from cells to blood, and excessive potassium intake. Patients with kidney disease or
This document discusses three conditions that can cause pruritus (itching) during pregnancy: intrahepatic cholestasis of pregnancy (ICP), PUPPP (pruritic urticarial papules and plaques of pregnancy), and herpes gestationis (pemphigoid gestationis). ICP is characterized by pruritus and abnormal liver function tests that resolve after delivery. It is caused by high estrogen levels impairing bile acid transport. PUPPP features erythematous papules that coalesce into urticarial plaques on the abdomen and thighs. Herpes gestationis involves urticarial papules and plaques that may develop into bullae, often sparing the face,
1) 7 year old boy presented with nausea, vomiting, sweating, abdominal pain, and jaundice after accidentally ingesting an unknown syrup the previous night. Examination found hepatomegaly. He was diagnosed with paracetamol poisoning.
2) Paracetamol is metabolized in the liver. In overdose, glutathione stores are depleted allowing a toxic metabolite to bind to hepatocytes and cause liver damage. Paracetamol poisoning management includes gastric lavage, N-acetylcysteine as an antidote to prevent binding, and monitoring for liver transplantation.
Partogram is a useful tool for the assessment and management of labour. This presentation describes the method to plot partogram and means how to assess prolonged labour by using it.
1) Pregnancy induced hypertension complicates 5-10% of pregnancies and is a leading cause of maternal mortality. It includes gestational hypertension, preeclampsia, and chronic hypertension.
2) Preeclampsia is diagnosed when a woman develops high blood pressure and protein in the urine after 20 weeks of pregnancy. Symptoms can include headaches, abdominal pain, and vision changes.
3) Management of mild preeclampsia involves outpatient monitoring while management of severe preeclampsia requires hospitalization, magnesium sulfate treatment, and sometimes antihypertensive drugs. Delivery is the definitive treatment when the condition becomes severe or the pregnancy reaches term.
Depo-Provera CI (Medroxyprogesterone Acetate Injectable Suspension) The Swiss Pharmacy
Depo-Provera Contraceptive Injection (Medroxyprogesterone Acetate injectable Suspension) is a progestin indicated for use by females of reproductive potential to prevent pregnancy. It is also used to treat endometriosis, abnormal uterine bleeding, abnormal sexuality in males, and certain types of cancer.
Aspirin toxicity remains an important clinical problem due to aspirin's widespread availability and use. Aspirin is rapidly absorbed in the stomach and metabolized in the liver. Toxicity can cause a wide range of symptoms affecting multiple organ systems. Diagnosis is based on history of ingestion and characteristic laboratory abnormalities. Management involves gastric decontamination, fluid replacement, urine alkalinization, and hemodialysis in severe cases.
This document provides information on the management of acetaminophen (APAP) toxicity. It discusses the history of APAP use, its widespread presence in over-the-counter medications, pharmacological actions, pharmacokinetics, toxicity risks, stages of poisoning, and treatment with N-acetylcysteine (NAC). It emphasizes the importance of timely NAC administration based on the Rumack-Matthew nomogram to prevent hepatic damage from APAP overdose. Two case studies demonstrate the application of these principles in clinical practice.
This document discusses acute kidney injury (AKI), formerly known as acute renal failure. It defines AKI as the rapid deterioration of renal function over hours to days, resulting in the failure of the kidneys to excrete waste and regulate fluids and electrolytes. AKI can be classified in different ways, including whether urine output is low or normal. Prerenal, renal, and postrenal causes of AKI are described. The epidemiology, etiology, diagnosis, and management of AKI are also outlined. Treatment involves supportive care through fluid management, electrolyte correction, and potentially renal replacement therapy in severe cases.
1) Salicylate poisoning can occur from overdose of aspirin and other salicylate-containing medications and is a potentially serious toxicity.
2) Symptoms range from mild nausea and vomiting to seizures, coma and death depending on the dose ingested.
3) Treatment involves gastric decontamination, fluid resuscitation, urinary alkalinization to enhance elimination of salicylates, and hemodialysis for severe or refractory cases.
LABETALOL is non selective beta blocker drug , mainly used in treatment of hypertension its uses are given ...drug interactions are given and also side effects
A 34-year-old British woman presented to the emergency department 30 minutes after ingesting approximately 100 acetaminophen tablets with alcohol in a suspected suicide attempt. She was treated with activated charcoal and intravenous N-acetylcysteine. On the first day of admission she developed abdominal pain and vomiting. Her liver function tests remained normal during her 3-day admission before she discharged herself against medical advice to return to the UK. Paracetamol overdose is commonly seen and requires prompt treatment with N-acetylcysteine to prevent liver damage from toxic metabolite accumulation if ingestion exceeds toxic thresholds.
Paracetamol toxicity or Acetaminophen toxicityVHARI5
1) Acetaminophen toxicity is a common cause of liver damage due to its easy availability and perception as being safe. Toxicity occurs when more than 7.5g is ingested, causing liver damage by depleting glutathione stores and allowing a reactive metabolite to bind hepatocytes.
2) Symptoms of acute acetaminophen toxicity include nausea, vomiting, and jaundice within 72 hours as the liver is damaged. Without treatment, liver failure and death can occur. Treatment involves administering N-acetylcysteine as an antidote if toxicity is suspected based on amount ingested.
3) Chronic excessive acetaminophen use can also cause toxicity, especially in alcoholics
this presentation is about the acetaminophen or paracetamol as its second name and its overdose reactions and activities. and its toxic effects that may be harmful and cause damages in the people.
This document discusses hypertension in pregnancy, including classifications, diagnostic criteria, risk factors, pathophysiology, prevention, and management. It classifies hypertensive disorders in pregnancy into four categories: gestational hypertension, preeclampsia, chronic hypertension, and chronic hypertension with superimposed preeclampsia. It provides diagnostic criteria for each condition and indicators of severity. Risk factors include young maternal age, obesity, multifetal gestation, and genetic predispositions. The pathophysiology involves abnormal placental invasion and maternal inflammatory response. Management depends on severity of features and gestational age, ranging from expectant monitoring to expedited delivery.
This presentation discusses paracetamol toxicity and provides information on its definition, history of use, therapeutic uses, toxicokinetics, mechanisms of toxicity, clinical features of acute and chronic overdose, diagnosis, and treatment including use of activated charcoal, N-acetylcysteine, methionine, and liver transplantation in severe cases. Key points covered include paracetamol's mechanism of hepatotoxicity through production of the reactive intermediate NAPQI, signs of liver damage that present 2-3 days after overdose, and the importance of administering N-acetylcysteine within 10 hours of ingestion to prevent liver injury.
The document discusses acetaminophen poisoning in children. It describes acetaminophen as a drug with analgesic and antipyretic properties that can cause toxicity when too much is ingested. The toxicity results from a reactive metabolite that depletes glutathione stores in the liver. It outlines the stages of acetaminophen toxicity and emphasizes the importance of rapid treatment with N-acetylcysteine to prevent liver damage. Diagnosis involves measuring acetaminophen levels in conjunction with liver enzymes and coagulation factors.
Propranolol is the most common beta-blocker involved in severe beta-blocker poisoning. It is nonselective and can lead to CNS depression, seizures, and prolongation of the QRS complex.
Beta blocker toxicity is notably distinguished by bradycardia, low respiratory
rate and hypoglycemia
Seizures and other CNS effects can occur with beta blockers that can cross the blood brain barrier (more rarely with the other beta blockers)
Overdoses of beta blockers with a combination of other drugs can have wide
ranging systemic effects
If within a short time after ingestion, give activated charcoal
Treat with glucagon to raise blood glucose levels
Widely used treatment is currently Atropine though it is considered less effective
Treat bronchospasm with beta agonists like Albuterol
Treat Seizures with Benzodiazepines like Valium
If the patient is still unresponsive or the condition is still deteriorating, treat with epinephrine
Management of hyperkalemia dakahlia medical syndicate 2o18FAARRAG
This document discusses hyperkalemia (high potassium levels), including its definition, classification, causes, and approach to assessment and management. Some key points:
- Hyperkalemia is defined as a serum potassium level above 5.0-5.5 mEq/L in adults and can be mild (5.5-6.0 mEq/L), moderate (6.1-7.0 mEq/L), or severe (≥7.0 mEq/L). Levels over 7-8.5 mEq/L can cause cardiac issues.
- Causes include reduced renal excretion, shifts of potassium from cells to blood, and excessive potassium intake. Patients with kidney disease or
This document discusses three conditions that can cause pruritus (itching) during pregnancy: intrahepatic cholestasis of pregnancy (ICP), PUPPP (pruritic urticarial papules and plaques of pregnancy), and herpes gestationis (pemphigoid gestationis). ICP is characterized by pruritus and abnormal liver function tests that resolve after delivery. It is caused by high estrogen levels impairing bile acid transport. PUPPP features erythematous papules that coalesce into urticarial plaques on the abdomen and thighs. Herpes gestationis involves urticarial papules and plaques that may develop into bullae, often sparing the face,
1) 7 year old boy presented with nausea, vomiting, sweating, abdominal pain, and jaundice after accidentally ingesting an unknown syrup the previous night. Examination found hepatomegaly. He was diagnosed with paracetamol poisoning.
2) Paracetamol is metabolized in the liver. In overdose, glutathione stores are depleted allowing a toxic metabolite to bind to hepatocytes and cause liver damage. Paracetamol poisoning management includes gastric lavage, N-acetylcysteine as an antidote to prevent binding, and monitoring for liver transplantation.
Partogram is a useful tool for the assessment and management of labour. This presentation describes the method to plot partogram and means how to assess prolonged labour by using it.
1) Pregnancy induced hypertension complicates 5-10% of pregnancies and is a leading cause of maternal mortality. It includes gestational hypertension, preeclampsia, and chronic hypertension.
2) Preeclampsia is diagnosed when a woman develops high blood pressure and protein in the urine after 20 weeks of pregnancy. Symptoms can include headaches, abdominal pain, and vision changes.
3) Management of mild preeclampsia involves outpatient monitoring while management of severe preeclampsia requires hospitalization, magnesium sulfate treatment, and sometimes antihypertensive drugs. Delivery is the definitive treatment when the condition becomes severe or the pregnancy reaches term.
Depo-Provera CI (Medroxyprogesterone Acetate Injectable Suspension) The Swiss Pharmacy
Depo-Provera Contraceptive Injection (Medroxyprogesterone Acetate injectable Suspension) is a progestin indicated for use by females of reproductive potential to prevent pregnancy. It is also used to treat endometriosis, abnormal uterine bleeding, abnormal sexuality in males, and certain types of cancer.
Aspirin toxicity remains an important clinical problem due to aspirin's widespread availability and use. Aspirin is rapidly absorbed in the stomach and metabolized in the liver. Toxicity can cause a wide range of symptoms affecting multiple organ systems. Diagnosis is based on history of ingestion and characteristic laboratory abnormalities. Management involves gastric decontamination, fluid replacement, urine alkalinization, and hemodialysis in severe cases.
This document provides information on the management of acetaminophen (APAP) toxicity. It discusses the history of APAP use, its widespread presence in over-the-counter medications, pharmacological actions, pharmacokinetics, toxicity risks, stages of poisoning, and treatment with N-acetylcysteine (NAC). It emphasizes the importance of timely NAC administration based on the Rumack-Matthew nomogram to prevent hepatic damage from APAP overdose. Two case studies demonstrate the application of these principles in clinical practice.
This document discusses acute kidney injury (AKI), formerly known as acute renal failure. It defines AKI as the rapid deterioration of renal function over hours to days, resulting in the failure of the kidneys to excrete waste and regulate fluids and electrolytes. AKI can be classified in different ways, including whether urine output is low or normal. Prerenal, renal, and postrenal causes of AKI are described. The epidemiology, etiology, diagnosis, and management of AKI are also outlined. Treatment involves supportive care through fluid management, electrolyte correction, and potentially renal replacement therapy in severe cases.
1) Salicylate poisoning can occur from overdose of aspirin and other salicylate-containing medications and is a potentially serious toxicity.
2) Symptoms range from mild nausea and vomiting to seizures, coma and death depending on the dose ingested.
3) Treatment involves gastric decontamination, fluid resuscitation, urinary alkalinization to enhance elimination of salicylates, and hemodialysis for severe or refractory cases.
LABETALOL is non selective beta blocker drug , mainly used in treatment of hypertension its uses are given ...drug interactions are given and also side effects
A 34-year-old British woman presented to the emergency department 30 minutes after ingesting approximately 100 acetaminophen tablets with alcohol in a suspected suicide attempt. She was treated with activated charcoal and intravenous N-acetylcysteine. On the first day of admission she developed abdominal pain and vomiting. Her liver function tests remained normal during her 3-day admission before she discharged herself against medical advice to return to the UK. Paracetamol overdose is commonly seen and requires prompt treatment with N-acetylcysteine to prevent liver damage from toxic metabolite accumulation if ingestion exceeds toxic thresholds.
Paracetamol toxicity or Acetaminophen toxicityVHARI5
1) Acetaminophen toxicity is a common cause of liver damage due to its easy availability and perception as being safe. Toxicity occurs when more than 7.5g is ingested, causing liver damage by depleting glutathione stores and allowing a reactive metabolite to bind hepatocytes.
2) Symptoms of acute acetaminophen toxicity include nausea, vomiting, and jaundice within 72 hours as the liver is damaged. Without treatment, liver failure and death can occur. Treatment involves administering N-acetylcysteine as an antidote if toxicity is suspected based on amount ingested.
3) Chronic excessive acetaminophen use can also cause toxicity, especially in alcoholics
Case study on paracetamol poisoning(Acetaminophen toxicity)Neeraj Ojha
1) A 16-year-old female was brought to the emergency department six hours after a suspected acetaminophen and alcohol overdose in an apparent suicide attempt following a breakup.
2) Laboratory tests showed mildly elevated liver enzymes and an acetaminophen level of 308 ug/mL, above the toxic threshold.
3) She received oral activated charcoal and intravenous N-acetylcysteine in the hospital over 72 hours, with transient increases in liver enzymes but ultimately an uneventful recovery.
The document summarizes key aspects of acetaminophen toxicity including its biochemical basis, factors that influence toxicity, clinical manifestations, diagnosis, and treatment. Acetaminophen is mostly metabolized safely but can cause liver damage if it depletes glutathione stores, allowing a toxic metabolite to accumulate and bind hepatocytes. Chronic alcoholics are particularly at risk due to induced cytochrome enzymes. Treatment involves gastric decontamination and N-acetylcysteine administration within 10 hours of overdose to prevent liver injury.
Paracetamol, also known as acetaminophen, is a widely used over-the-counter analgesic and antipyretic drug. While generally safe in therapeutic doses, paracetamol overdose can cause acute liver failure. Paracetamol is metabolized in the liver, but a small percentage is converted to a toxic metabolite that depletes glutathione stores and causes liver damage. N-acetylcysteine is the antidote of choice and works by replenishing glutathione levels; it is most effective if given within 10 hours of ingestion. Without treatment, paracetamol overdose can progress to liver failure and death.
Paracetamol poisoning admissions to the Poison Treatment Center in New York have increased in recent years. Paracetamol is rapidly absorbed and causes liver damage through a toxic metabolite. Treatment involves assessing ingestion amount and time to determine if acetylcysteine (NAC) is needed. NAC treatment is most effective when started within 8 hours and involves a 3-stage infusion or oral dosing. While reactions can occur, NAC is the antidote for paracetamol overdose and aims to prevent liver injury.
Management of Acetaminophen Toxicity1.pptpaulmarino21
This document discusses the management of acetaminophen (APAP) toxicity. It provides details on APAP's history, pharmacokinetics, toxicity, and treatments. For acute overdoses, the Rumack-Matthew nomogram can help determine toxicity based on APAP blood levels and time since ingestion. Intravenous N-acetylcysteine (NAC) is the antidote and should be given as soon as possible to protect the liver, even if APAP levels are unknown or more than 24 hours post-ingestion. Timely NAC treatment can prevent hepatic damage from an APAP overdose.
This document summarizes paracetamol (acetaminophen) poisoning. It describes paracetamol as a non-steroidal anti-inflammatory drug with analgesic and antipyretic properties. It acts by inhibiting cyclooxygenase enzymes. The document outlines the pharmacokinetics, metabolism, toxic dose, and mechanism of toxicity for paracetamol poisoning. It also describes the four stages of paracetamol intoxication and the approach, investigations, management including N-acetylcysteine, and supportive care for paracetamol overdose.
Paracetamol 500mg tablets smpc taj pharmaceuticalsTaj Pharma
Paracetamol Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warnings, Paracetamol Dosage & Rx Info | Paracetamol Uses, Side Effects -: Indications, Side Effects, Warnings, Paracetamol - Drug Information - Taj Pharma, Paracetamol dose Taj pharmaceuticals Paracetamol interactions, Taj Pharmaceutical Paracetamol contraindications, Paracetamol price, Paracetamol Taj Pharma Paracetamol 500mg Tablets SMPC- Taj Pharma . Stay connected to all updated on Paracetamol Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
Paracetamol (acetaminophen) poisoning is the most common drug overdose. As little as 12g can be fatal through liver damage caused by a toxic byproduct of paracetamol metabolism called NAPQI. NAPQI is normally detoxified by glutathione in the liver, but an overdose can deplete glutathione leading to liver necrosis. Treatment for paracetamol overdose depends on time of presentation - activated charcoal is used if under 8 hours, while N-acetylcysteine is the antidote of choice to replenish glutathione if 8-24 hours after ingestion. Prognosis is worst with grade IV hepatic coma, acidosis, high creatinine,
This document summarizes common types of drug poisonings, including accidental, deliberate self-poisoning, and homicide. It discusses incidence, common drugs involved like paracetamol and aspirin, clinical features, investigations, and general management principles like preventing absorption, enhancing elimination, and specific pharmacological interventions. For some specific drugs, it provides details on mechanisms of toxicity, clinical presentations, and treatment approaches.
This document summarizes information about paracetamol poisoning, including statistics on cases from 2015-2018 at a poison treatment center. It describes the absorption, distribution, and metabolism of paracetamol. Threshold doses for potential hepatic injury are provided for both single and repeated ingestions in adults, children, and high-risk groups. The clinical features and phases of paracetamol poisoning are outlined. Recommended investigations and treatment with N-acetylcysteine via three-stage infusion are summarized, along with potential reactions and alternative oral treatment. Timely treatment with NAC is emphasized as crucial to prevent liver toxicity.
detailed approach for the treatment of paracetamol toxicity including toxicity dose, pathophysiology, diagnosis, treatment and indications of liver transplant referral
Drug Monograph and Literature Review: "Arcapta Neohaler"Joy Awoniyi
This document provides a drug monograph and literature review for Arcapta Neohaler, which contains indacaterol maleate. It is approved for the treatment of chronic obstructive pulmonary disease (COPD) as a once-daily long-acting beta agonist. The monograph details the drug's indications, dosage forms, mechanism of action, pharmacokinetics, contraindications, warnings, adverse effects, drug interactions, and dosing. It concludes with a review of the literature on indacaterol maleate and COPD treatment.
This document discusses poisoning classifications and treatments. It provides statistics on poisoning incidence and the most common substances involved. Key points include:
- Accidental poisoning is most common in children under 5, while deliberate self-poisoning is common in adults over 15.
- Paracetamol and aspirin are among the most frequent causes of poisoning.
- Treatment focuses on preventing further drug absorption, increasing elimination, and using specific antidotes like n-acetylcysteine for paracetamol overdose.
- Poisoning management involves supportive care, monitoring, gastric decontamination methods, and increasing drug metabolism or excretion depending on the substance ingested.
This document summarizes information on various types of poisonings and drug overdoses. It discusses accidental, deliberate, and non-accidental poisonings. It then provides details on the incidence, common drugs involved, and general management approach for poisonings. The document also provides more in-depth information on the presentation, evaluation, and specific treatment approaches for paracetamol/acetaminophen, salicylate/aspirin, NSAID, and anticholinergic poisonings.
This document discusses poisoning classifications and treatments. It provides statistics on poisoning incidence and the most common substances involved. Key points include:
- Accidental poisoning is most common in children under 5, while deliberate self-poisoning is common in adults over 15.
- Paracetamol and aspirin are among the most frequent causes of poisoning.
- Treatment focuses on preventing further drug absorption, increasing elimination, and using specific antidotes like n-acetylcysteine for paracetamol overdose.
- Poisoning management involves supportive care, monitoring, gastric decontamination methods, and increasing drug metabolism or excretion depending on the substance ingested.
Lecture on some therapeutic poisons based on subject of Forensic Medicine. Aspirin , Salicylate, aconite and barbiturates poisoning is beutifully explaned with treatments
Systemic therapies such as targeted agents (TKIs) and immune checkpoint inhibitors are increasingly used to treat advanced hepatocellular carcinoma (HCC). These therapies can cause adverse events that require careful management. TKIs commonly cause hand-foot skin reactions, which are graded based on severity from 1-3. Management involves prophylaxis like moisturizing and avoiding friction, along with topical steroids and potentially dose reductions. Immune checkpoint inhibitors can cause immune-related adverse events affecting many organ systems from 1-4 based on severity. Most grade 1-2 events are managed with corticosteroids and holding immunotherapy, while higher grades often require high-dose steroids, other immunosuppression, and potentially discontin
Similar to Management of paracetamol overdose in adults (20)
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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learning occurs when a stimulus (unconditioned stimulus) eliciting a response (unconditioned response) • is paired with another stimulus (conditioned stimulus)
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We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
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Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
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Combining endocrine therapy with other treatments enhances efficacy. Examples include:
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Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
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Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
2. History of Paracetamol.
Epidemiology.
Pathophysiology.
Clinical presentation.
Management.
Overview:
3. Paracetamol was first used clinically by Von Mering in 1893,
appeared commercially on 1950 in USA and Australia with
extreme safe record. 5
During 1960s and 1970s, concerns were raised about toxicity of
OTC analgesics.
1966 discovery that major overdose of paracetamol could be
complicated by severe, sometimes fatal, liver damage.
1980 was the turning point where Paracetamol started being
widely used in Paeds after linking Aspirin to Reye’s Syndrome
History:
7. Frequently involved in cases of poisoning and estimated to account
for over 40% of all self poisoning cases presenting to hospitals in
England. 1-2
Approximately 200-250 Deaths/yr in England and Wales. 3
In 2018 Paracetamol comprised to 210 Deaths in England and Wales. 4
Accidental overdose patiets had a higher rates of severe
hepatotoxicity, Hepatic coma and Death compared to those who
attempted suicide though the latter had more paracetamol. 6
Annually 30.000-40.000 cases of paracetamol overdose present to
A&E. comprsong 48% of admission for self-poisoning, 10% requires
Antidote. 7
Epidemiology:
8. Self Harm
Iatrogenic:
Inadequate explanation of directions to use.
Over administration in wards and care homes.
Failure to recognize that Paracetamol is found in more than one
medication and not explaining that to patient.
Pattern of use:
Repeated supratherapeutic dose where patient ingest a high dose in
attempt to relief pain or for fever. Such patients might be either fasting or
chronic alcoholics and more likely to present to medical care late when
toxic effects are already established.
Repeated therapeutic doses which results in mild, self-limiting, clinically
insignificant transaminase elevation ( ALT).
Causes:
9. Paracetamol is absorbed completely at the duodenum.
Peak serum concentration at 1-2 hours post ingestion.
Peak plasma levels at 4 hours post ingestion of an immediate
release formula.
Drugs that delays gastric emptying, or extended release
formulas, will prolong peak serum levels for up to 8 hours.
Elimination half-life is between 0.9-4 hours and it can get up to
17 hours if there is an underlying hepatic dysfunction.
Pathophysiology:
10. Paracetamol is metabolized by conjugation in liver to a nontoxic,
water-soluble compound which is finally excreted in urine.
In overdose, conjugation becomes saturated and excess
paracetamol is oxidatively metabolized by CY enzymes ( 2E1, 1A2,
2A6, 3A4) to produce the heapatotoxic NAPQi (N-Acetyl-P-
Benzoquinoneimine)
NAPQi has a short half life and is rapidly conjugated to Glutathione
and excreted in urine
Toxicity appears when NAPQi is excessively produced or when
Glutathion is reduced to 70%.
11. NAPQi covalently binds to cesteniyl sulfhydryl groups
of hepatocellular protein ( particularly mitochondrial)
to form NAPQi protein products, an irreversible
product, resulting in a cascade of oxidative
hepatocyte injury, mitochondrial dysfunction,
alteration to mitochondrial ATP-synthase alpha and
centrilobular hepatocellular necrosis.
13. Minimum toxic dose for a single ingestion:
7.5-10 gm in Adult 15-20 tablets of 500 mg Paracetamol.
150 mg/kg -200 mg/kg in children 1-6 years of age.
Clinical manifestations of hepatotoxicity do not manifest until
24-48 hours post ingestion.
There is no early clinical symptoms that would predict toxicity.
So assessment on early stages in mainly achieved through a
proper history ( Time, amount and formula of ingestion) and
laboratory results.
Clinical Manifestations:
14. Phase 1:
Occurs 30 min to 24 hours post ingestion
Ranging between asymptomatic to Anorexia, Malaise
and Nausea and Vomiting.
Clinical manifestation phases:
15. Phase 2:
18-72 hours post ingestion.
Symptoms might initially improve during this stage.
Patient might complain of RUQ pain and tenderness,
anorexia, nausea, vomiting.
Tachycardia and hypotension reflects volume depletion.
Some patients might have oliguria.
16. Phase 3:
72-96 hours post ingestion.
Same clinical manifestations of phase 2.
Signs of hepatic necrosis or dysfunction: jaundice, hypoglycaemia,
hepatic coagulopathy, lactic acidosis, hyperammonemia, total
bilirubin >4.0 mg/dl and hepatic encephalopathy.
AKI in some severely ill patients.
Death due to multiorgan failure.
17. Phase 4:
The recovery phase
Lasts between 4 days to 3-4 weeks for those who
survive phase 3.
18. Acute Markers:
INR
PT
Lactate
Aminotransferases ( >3000 iu/l)
RFT
LVT ( AST:ALT > 2 in chronic use)
Paracetamol level is best taken at 4 hour post ingestion if
time is known or immediately at presentation if not.
BM
Investigations:
19. Alcoholic hepatitis.
Other drug or toxin induced hepatitis.
Viral hepatitis (total Bilirubin >1mg/dl).
Hepatobiliary disease.
Reye’s Syndrome.
Ischemic hepatitis.
Differential diagnosis:
20. Immediate release preparations:
There is no correlation between the amount of paracetamol
ingested or serum concentration measured i.e dose history does
not predict hepatotoxicity.
If timing is unclear, paracetamol level immediately and repeat after
4 hours.
If initial paracetamol levels is normal, patient must stay under
observation for 4 hours.
If initial level in undetectable, the decision on weather to give NAC
or not is based on presence of absence of lab indicators of
hepatotoxicity. If in doubt, start NAC.
Unknown time or > 8hrs, start NAC immediately before lab results.
Evaluation of Acute Ingestion:
21. Sustained release formulas:
No sufficient experience to know weather Rumack-
Matthew nomogram can assess risk.
It is recommended to measure paracetamol levels at 4
and 8 hours post ingestion.
Start NAC at the first high reading.
22. Repeated supratherapeutic ingestion:
Requires more in-depth history ( dose, pattern of use etc..)
Clinical manifestations are insidious in onset, often non-specific and
easily confused with alternate diagnosis.
Paracetamol levels are always high and do not correlate with
hepatotoxicity as with the acute presentation.
Requires assessment of hepatic toxicity risk
23. Assessment of hepatotoxicity risk:
Patient is at an increased risk if history, clinical and lab data are
positive plus any of the following:
>7.5 g over 24 hrs + chronic alcohol, malnourished, drugs that increase
CYP450 activity.
Abdominal pain, liver tenderness, nausia, vomiting, jaundice or patient
is ill appearing.
Detectable paracetamol levels (above treatment line) with or without
increase in ALT.
increased ALT >50 u/l with history of paracetamol ingestion regardless
paracetamol levels.
Hepatotoxicity ALT >1000 u/l while acute liver injury ALT >50 u/l
24. Elevated paracetamol-Aminotransferase
multiplication product:
On presentation, it predicts hepatotoxicity regardless
time.
(Paracetamol level × ALT)
Sensitivity of 100% however, drops to 54% at 8 hours.
Cut-off point is 10.000 where above is hepatotoxicity
and below is not.
25. • Used at 4 hours
• Not useful after 24 hours
• Not useful for sustained release
formulas.
• Treatment line is actually 25% lower
than the actual line as a safety margin
which protects susceptible patients
who are at high risk of developing
hepatotoxicity.
Modified Rumack-Matthew
nomogram
26. G.I decontamination:
Activated charcoal (AC)at 1 gm/kg ( maximum of 50 gm) p.o within
the first four hours of ingestion.
AC should not be given to patients who cannot maintain their
airway.
It was found that patients are less likely to develop liver injury if AC
was given before NAC. 6
One study found that those who had AC in the first 2 hours had no
need to take NAC. 6
One study suggested administration of AC post 4 hours may be
beneficial. 6
Management:
27. Is theorized to work through different mechanisms
It is a precursor of Glutathione.
Enhance sulfate conjugation of unmetabolized paracetamol.
Function as anti-inflammatory and Antioxidant.
Has positive inotropic effect
Increase local nitric oxide.
Ideally given within the first 8 Hours of acute ingestion. However,
it should be given regardless time.
It reduces mortality in late presenting patients with fulminant
hepatic failure even in the absence of measurable paracetamol
level.
N-Acetyl Cysteine (NAC):
28. Indications:
Serum paracetamol above treatment line.
suspected ingestion of >/= 7.5 gm of paracetamol in patient who
serum paracetamol levels will not be available immediately or
delayed after 8 hours of ingestion.
Unknown time of ingestion.
History of ingestion and evidence of liver injury.
Delayed presentation (> 24 hours) consisting of Lab evidence of
liver injury and history of excessive ingestion.
Massive overdose requires larger dose of NAC. However, no
controlled studies demonstrated that increasing dose would
prevent liver injury.
29. Administration:
UK protocol was adopted on 1970 and still in use.
20 hours I.V protocol as follows:
Initial dose of 150 mg/kg I.V. over 15-60 min ( recommended 60 min-6-).
Next 50 mg/kg over 4 hours.
Finally 100 mg/kg over 16 hours.
Effect of weight: current dosing protocols is calculated on maximum
body weight of 100 kg. However, there is no evidence that dose
calculated with body weight above 100 kg has provided added benefit. 6
Dose based on actual body weight or estimated body weight is
acceptable. 6
Consider antiemetic such as single dose Ondansetron 4-8 mg I.V. (6)
30. Adverse reactions:
Anaphylaxis:
12-20% of patients develop hypersensitivity.
It is warrant to keep close monitoring when giving NAC.
There is limited evidence regarding continuation of NAC in patient
with anaphylaxis. Contact local poison control centre. 6
31. Suggested approach with Anaphylaxis: 6
Patient with flushing without pruritus: continue NAC unless severe
signs develop.
Patient who develop Urticaria: Stop infusion immediately. Treat
with Epinephrine, Steroids, Antihistamine and Salbutamol if wheezy.
Restart infusion if patient improve.
Patient who develop hypotension or persistent anaphylactic
symptoms: Stop NAC, treat anaphylaxis and DO NOT resume NAC.
Oral NAC should be provided. 6
32. Oral Methionine is useful if: (8)
Allergy to NAC.
Difficulty obtaining or maintaining I.V line.
Patient does not wish to stay at the hospital (DAMA).
Awaiting plasma paracetamol concentration.
Dose of 2.5 g initially followed by three further doses of 2.5 g
every 4 hours.
Avoid if patient is vomiting or AC has been given
33. When to stop NAC?
For acute ingestion:
When ALT is not elevated, INR <2.0 or ALT is acceptably decreasing
(consult your senior) stop at 20 hours.
Check ALT at 18 hours, if still high or Paracetamol is still detectable,
continue treatment for 4 hours at 6.25 mg/kg/hr for 4 hours.
For repeated ingestion, ALT is not elevated
NAC for 12 hours
Check ALT at 11 hours if high or paracetamol is detectable continue
6.25 mg/kg/hr for 12 hours.
34. Alcohol:
Acute ingestion: does not appear to be a risk factor for hepatotoxicity
and maybe protective as it competes with paracetamol for CYP2E1
resulting in reduced NAPQi
Chronic ingestion:
It appears to be no evidence of increased hepatotoxicity in chronic
alcoholics who take therapeutic dose of paracetamol. However, individual
factors vary. 6
Single overdose: evidence suggest no increase risk compared to non-
alcoholics for developing hepatotoxicity. Management remains the same.
Multiple overdose: Chronic alcoholics appears to be at increased risk of
hepatotoxicity. Risk factors include malnutrition, recent fasting and
depleted hepatic Glutathione.
Special conditions:
35. Chronic liver disease:
Patient with chronic liver disease who do not regularly ingest
alcohol do not appear to be at risk of hepatotoxicity.
Note that paracetamol metabolism is reduced and half life is more
than 4 hours.
More importantly, CYP450 is low and cannot be induced leading
to hepatic protection.
It is generally recommended that no more than 2 g to be given in
24 hours.
37. Tobacco:
It is an indepenmdant risk factor for mortality
depending on the amount. Mortality was higher in
smokers who also consume Alcohol.
Cigarettes contain CYP1A2 inducers leading to increase
oxidative metabolism
38. Pregnancy:
No difference on essential elements of treatment.
Paracetamol can cause foetal and neonatal death from
hepatic necrosis.
Treatment is indicated if Paracetamol >20 mcg/ml or
serum transaminases >50 u/l.
It is likely that maternal toxicity would increase risk of
adverse pregnancy outcome. 6
39. Outcome is nearly always good if NAC is given in timely
fashion.
When fulminant hepatic failure and death occur?
Usually from delays in seeking medical attention, recognition of
poisoning or delays in starting the appropriate therapy.
Prognosis
40.
41. 1-Hawton K, Bergen H, Casey D, et al. Self-harm in England: a tale of three cities. Multicentre study of self-
harm. Soc Psychiatry Psychiatr Epidemiol 2007;42:513–21
2-Prescott K, Stratton R, Freyer A, et al. Detailed analyses of self-poisoning episodes presenting to a large
regional teaching hospital in the UK. Br J Clin Pharmacol 2009;68:260–8
3-Office for National Statistics. Deaths related to drug poisoning: England and Wales, 2011. Statistical Bulletin
ONS, 2011.
4- Office for national statistics: Deaths related to drug poisoning in England and Wales: 2018 registrations.
5-Paracetamol: Past, Present, and Future L F Prescott PMID: 11319582.
6- Up to Date: Acetaminophen (paracetamol) poisoning in adults: Pathophysiology, presentation, and
evaluation
7-PARACETAMOL POISONING: CAN IT BE PREVENTED? E. Norman, Medical Student, R. Dhairiwan, Medical
Student, United Medical and Dental School of Guy’s and St Thomas’, London; P.I. Dargan, Registrar in
Medical Toxicology, C. Wallace, Registrar in Medical Toxicology and A.L. Jones, Consultant Physician and
Clinical Toxicologist, National Poisons Information Service, Guy’s and St Thomas’ NHS Trust, London
8-Emergency Medicine Lecture notes by Chris Moulton, David Yates 4th edition
9-Medscape
10-BMJ best practice
11-BNF
References: