Treatment of Paracetamol Toxicity

  Although clinical evidence of hepatotoxicity may be delayed for 24 to 72 hours, NAC therapy is most effective if started within 8 hours of ingestion. Because this patient reported the ingestion within 30 minutes, there is time for a serum APAP level, activated charcoal decontamination, and then NAC therapy. If time is an issue, NAC treatment should be initiated without delay. Emesis should not be induced because of the possible delay in therapy. After medical stabilization, assessment of suicide potential is important. SECTION II: CLINICAL

Paracetamol Toxicity causes, symptoms complications

Acetaminophen (APAP) is one of the most commonly used analgesics and antipyretics. It is available in a variety of prescription, over-the-counter, and combination medications labeled for fever, cold, cough, and pain relief. As a result, it is the most common over-the-counter agent reported in accidental and intentional overdoses, leading to more hospitalizations after overdose than any other pharmaceutical agent. A toxic exposure to APAP is suspected when more than 200 mg/kg or more than 10 g is ingested in a single dose or over the course of 24 hours. In addition, an ingestion of more than 150 mg/kg or more than 6 g per day for at least 2 consecutive days is potentially toxic. Hepatotoxicity is the most life-threatening complication, but may be indolent; thus, serum APAP level and a precise time of ingestion are important to plot on a nomogram to assess likelihood of toxicity.