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Acetaminophen Overdose Pathway

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This video will go over a pathway I created that simplifies Acetaminophen overdose as well as the process of alcohol inducing or inhibiting this system.

Hi everyone and welcome back to dr coco’s medmonics today i’m going to be going over acetaminophen overdose this is not so much of mnemonic as much as the pathway that i wrote out that really helped me get every single acetaminophen overdose question right and i tried to learn this pathway through sketchy and um through first aid in for some reason i’ve really

Really struggled and i would get all these questions wrong until i just drew this out and made it seem almost effortless to get these questions right so let’s just go ahead and look so when you take acetaminophen two percent of it is just gonna be excreted unchanged in your urine and ninety percent of it is going to go through sulfonization and gluconerization

And then it’s just gonna be peed out and right there we already have 92 percent of the acetaminophen that we took is excreted well what about the next eight percent so that eight percent is going to go through the cyp 450 system and converted to napqi that napqi is too big to be excreted and so it has to be conjugated with glutathione and glutathione is made in

The liver so once you conjugate it with glutathione you can pee out the rest of this acetaminophen and this is just the normal breakdown of acetaminophen so what happens when you overdose well both the excretion unchanged and sophomorization and gluconerization will still happen but they’re gonna get overwhelmed with the amount that somebody takes and over to

Try and overdose on acetaminophen and so we’re going through this uip 450 system and eventually your liver is going to get so tired it’s like dude what’d you do to me and your that overdose will deplete the glutathione in your liver and so then you can’t get rid of that napqi and it’s going to start building up and napqi is hepatotoxic causing irreversible cell

Damage and so knowing the definition of irreversible versus reversible cell damage from either pathoma or first aid might help you figure out the answer to this question because we know that napqi is going to cause irreversible cell damage and so this is the pathway it’s pretty simple when you look at it this way i’m just thinking of it going through the cyp

450 breaking down into napqi and then using glutathione to pee it out but in an overdose your liver won’t be able to give you that glutathione that it needs so then you have a buildup of napqi another concept that was tested a lot in you world and i got multiple questions on was what happens if you overdose on acetaminophen but you were drinking alcohol and so

If you were an acute if you had acute alcohol in your system so you’re not in alcoholic you don’t have a chronic liver and toxicities you just decided to overdose with acetaminophen and drink some alcohol with it well that actually acute alcohol is an inhibitor of cyp450 and so it would be actually cytoprotective against this pathway because if you inhibit the

Cyp450 system it’s going to force all of it to go through the other two pathways of sulfonization gluconerization or just being excreted straight unchanged in the urine so if you overdose with acetaminophen and you’re a chronic alcoholic though that chronic alcohol is going to be an inducer of cyp450 and so that would actually cause even more damage um inducing

All of the acetaminophen that normally would have gone through the other two pathways they’re saying hey just come to the cyp 450 system like we’re gonna have a party over here and so chronic alcoholics will actually have even higher napqi causing even more hepatotoxic problems this might have been an easy pathway for some people but i really struggled so i hope

That drawing it out like this will help somebody get an answer right on nvme comp com say comlex usmle wherever and if you like my channel please like and subscribe

Transcribed from video
Acetaminophen Overdose Pathway By Dr. Cocoa’s MedMonics