Acetaminophen overdose resident survival guide: Difference between revisions
Line 45: | Line 45: | ||
Shown below is an algorithm summarizing the approach to <nowiki>[[Paracetamol Overdose]]</nowiki>. | Shown below is an algorithm summarizing the approach to <nowiki>[[Paracetamol Overdose]]</nowiki>. | ||
{{familytree/start |summary=PE diagnosis Algorithm.}} | {{familytree/start |summary=PE diagnosis Algorithm.}} | ||
{{familytree | | | | | | | | A01 |A01='''Characterize the symptoms & examine the patient:'''<br> Stage I: First 24 hours <br> ❑ Asymptomatic <br> ❑ Nausea & vomiting <br> ❑ Diaphoresis <br> ❑ Anion gap metabolic acidosis & coma (with massive doses) | {{familytree | | | | | | | | A01 |A01=<div style="float: left; text-align: left; line-height: 150% ">'''Characterize the symptoms & examine the patient:'''<br> Stage I: First 24 hours <br> ❑ Asymptomatic <br> ❑ Nausea & vomiting <br> ❑ Diaphoresis <br> ❑ Anion gap metabolic acidosis & coma (with massive doses) | ||
---- | ---- | ||
Stage II: 24 to 72 hours <br> ❑ Clinical & lab features of hepatotoxicity | Stage II: 24 to 72 hours <br> ❑ Clinical & lab features of hepatotoxicity | ||
Line 54: | Line 54: | ||
:* Deranged RFT's, proteinuria, hematuria, casts | :* Deranged RFT's, proteinuria, hematuria, casts | ||
---- | ---- | ||
Stage III: 72 to 96 hours}} | Stage III: 72 to 96 hours <br> Signs of liver failure <br> | ||
: ❑ Hepatic tenderness <br> | |||
: ❑ Jaundice <br> | |||
: ❑ Impaired consciousness <br> | |||
: ❑ Asterixis <br> | |||
: ❑ Foetur hepaticus <br> | |||
: ❑ Haemorrhage <br> | |||
Labs consistent with severe liver failure <br> | |||
: ❑ AST/ALT levels > 1000 mg/Dl <br> | |||
: ❑ Prolonged PT/INR <br> | |||
: ❑ Hypogycemia <br> | |||
: ❑ Lactic <br> | |||
: ❑ Total bilirubin > 4.0 <br> | |||
Renal failure <br> Death from multiorgan system failure | |||
---- | |||
Stage IV: 4 days to 2 weeks <br> ❑ Recovery </div> }} | |||
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }} | {{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }} | ||
{{familytree | | | B01 | | | | | | | | B02 | | |B01= |B02= }} | {{familytree | | | B01 | | | | | | | | B02 | | |B01= |B02= }} |
Revision as of 18:41, 10 January 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vidit Bhargava, M.B.B.S [2]
Definition
Acetaminophen overdose/toxicity occurs when there is intentional, accidental, acute and/or chronic ingestion of supratherapeutic doses of acetaminophen (paracetamol).
It is the most widely used OTC (over the counter) analgesic in USA. It is available in the U.S market under the following brand names.
Tylenol
Anacin-3
Liquiprin
Percocet
Tempra
Cold and flu medicines
Aceta
Actimin
Apacet>br>
Aspirin Free Anacin
Atasol
Banesin
Dapa
Datril Extra-Strength
Feverall
Fibi
Genapap
Genebs
Common dosage forms and strengths
- Suppository: 120 mg, 125 mg, 325 mg, 650 mg
- Chewable tablets: 80 mg
- Regular strength: 325 mg
- Extra strength: 500 mg
- Liquid: 160 mg/teaspoon
- Drops: 100 mg / mL, 120 mg / 2.5 mL
Toxic Dose
The toxic dose of paracetamol is highly variable. In individuals over 6 years of age, single doses above 200 mg/kg consumed over a single 24-hour period have a reasonable likelihood of causing toxicity. If an individual has consumed large quantities of paracetamol over a 48 hour period, a dose of above 6 grams or 150 mg/kg in the subsequent 24 hour period may cause toxicity.[1]
Management
Shown below is an algorithm summarizing the approach to [[Paracetamol Overdose]].
Characterize the symptoms & examine the patient: Stage I: First 24 hours ❑ Asymptomatic ❑ Nausea & vomiting ❑ Diaphoresis ❑ Anion gap metabolic acidosis & coma (with massive doses) Stage II: 24 to 72 hours
❑ Clinical & lab features of nephrotoxicity
Stage III: 72 to 96 hours
Labs consistent with severe liver failure
Renal failure Stage IV: 4 days to 2 weeks ❑ Recovery | |||||||||||||||||||||||||||||||||
References
- ↑ Dart RC, Erdman AR, Olson KR, Christianson G, Manoguerra AS, Chyka PA, Caravati EM, Wax PM, Keyes DC, Woolf AD, Scharman EJ, Booze LL, Troutman WG; American Association of Poison Control Centers (2006). "Acetaminophen poisoning: an evidence-based consensus guideline for out-of- hospital management". Clin Toxicol (Phila). 44 (1): 1–18. PMID 16496488.