Paracetamol (N-acetyl-p-aminophenol) is a common antipyretic and analgesic, that is used worldwide. It is the commonest taken drug overdose.
Signs and symptoms
Phase-1: 0.5–24 hours after ingestion:
Asymptomatic to nonspecific symptoms
Phase-2: 18–72 hours after ingestion:
• Right upper quadrant abdominal pain
• Tender right upper quadrant
Phase-3: 72–96 hours after ingestion:
All of the above
• Hepatic encephalopathy
• Acute renal failure
Phase-4: 4th day to 3weeks after ingestion:
• Patient who survive critical illness in phase 3, have complete recovery.
• Liver Function Test- ALT, AST, ALP, PT with INR (International Normalization Ratio)
• Renal Function Test: Electrolytes, BUN, creatinine
• ABG-Arterial Blood Gas
- • Rescucitation
• Usually there is no immediate threat to the airway, breathing and circulation with paracetamol poisoning
• Correct hypoglycaemia (Give glucose or sugar or honey)
• If within 1 hour of ingestion of 150mg/kg or more paracetamol give activated charcoal, if available, or induce vomiting.
- • Activated charcoal (1gm/kg, up to 50gm) if less than 2 hours.
If more than 8 hours after ingestion, or the patient cannot take oral treatment, give:
o Acetylcystein 150mg/kg IV in 200mls of 5% Dextrose over 20 minutes, then 50mg/kg in in 500mls of 5% dextrose over 4 hours, then 100mg/kg in 1 liter of 5% dextrose over 16 hours.
o In severe poisoning a further 100mg/kg may be given over the next 24 hours Children <20kg: Give loading dose of 150mg/kg in 3ml/kg of 5% glucose, over 15 minutes, followed by 50 mg/kg in 7 ml/kg of 5% glucose over 4 hours, then 100 mg/kg IV in 14 ml/kg of 5% glucose over 16 hours.
For conscious and not vomiting or when there is severe reaction to Nacetylcysteine give:
• Methionine (<6 years: 1 gram every 4 hours - 4 doses; 6 years and above: 2.5 grams every 4 hours for 4 doses).
Educate the patient on Dos and Don’ts of poisoning prevention.
• Keep medicines and poison in proper containers and out of reach of children
• Use containers with child resistant caps
• Keep all products in their original container
• Read medicine labels carefully to avoid mistake
• Leave container open
• Transfer products from their origin
• Remove labels from the medicine products
• Put tablets into another containers such as purse or envelope
• Medicine/tablets as sweet
• Take your medicine in front of children as they often copy
14 Novemba 2020 15:02:00
- 1. STG