TIPS TO MANAGE MENTAL HEALTH
PARACETAMOL (ACETAMINOPHEN) TOXICITY , SPECIFIC INGESTION & TREATMENT :
PARACETAMOL (ACETAMINOPHEN) TOXICITY , SPECIFIC INGESTION & TREATMENT :
Acetaminophen
(Paracetamol) :
Def:
·
an
antipyretic –analgesic
·
can
produce fatal Hepatotoxicity in the untreated patient through toxic metabolite
Available
dosage forms:
·
Available
in a variety of OTC & Prescription drug products.
Toxicokinetics:
·
Well
absorbed from GIT
·
Half-life between 2 and 3 hrs.
·
Less
than 5% excreted in Urine
·
Remainder
metabolized in the liver by Cytochrome P450
Clinical
Presentation:
1-Phase I (12 to 24Hrs Postingestion):
Nausea, Vomiting, Anorexia, and Diaphoresis
2- Phase II (1to 4 days Postingestion): Asymptomatic
3-Phase III(2 to 3days in untreated
patients): Nausea, Abdominal pain, Progressive evidence of Hepatic failure, coma,
and Death.
Laboratory
Data:
B-
Baseline LFT
C-
RFT
(BUN, SCr)
D-
Coagulation
study (PT, PTT, and Bleeding time)
Treatment:
1- Adult Patients: if ingested >10g or Children
ingested >200mg/kg require treatment.
Note: Elderly and alcoholics have increased susceptibility.
2-Recommended treatment
is GI Decontamination with activated
charcoal.
3-Antidotal therapy :
·
Recommended for the patients who have a toxic level of Acetaminophen
· NAC (N-Acetylcysteine )Dose:
A- 140mg/kg as loading dose
B- Followed by 70mg/kg every 4hr for a total of 17 doses
C- Oral or via nasogastric tube
D- NAC (Mucomyst) 20% contains 200mg/ml
E- Each dose must be diluted 1:3 in either cola or fruit juice to mask the unpleasant taste and smell
F- Dose should be a repeat if the patient vomits within 30mins of Adm.
G- If severe nausea secondary to NAC, pretreat with IV Metoclopramide (Reglan)10mg every 6hr.
H- Metoclopramide acts as An antiemetic while increasing the rate of NAC absorption.
· IV
NAC(Acetadote):
A-Loading dose:150mg/kg over 60
B- Manitenence dose:50mg/kg over 4hrs followed by 100mg/kg over 16hrs.
C- Anaphylactoid reactions: in approx 20% patient .
D- Caution Should be exercise with
patient having asthma.
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