This video “Acetaminophen (Paracetamol) Overdose” is part of the Lecturio course “Emergency Medicine” ► WATCH the complete course on
All right so we’re gonna talk a little bit about acetaminophen overdose which is actually a common and disturbing problem in the united states acetaminophen is also known as paracetamol and other settings and it’s a readily available over-the-counter drug that has high lethality potential and produces very minimum minimal symptoms at least in the initial phase
So the way acetaminophen works or the way that toxicity works i should say is that the liver metabolizes the acetaminophen into a compound called na pqi which is highly toxic now in normal doses of acetaminophen your na pqi is combined in the body with files that produces a non toxic metabolite which is then eliminated however in overdoses your file stores are
Depleted and the toxic metabolite accumulates now the main effect of acetaminophen is liver injury so in high doses acetaminophen can actually cause fulminant liver failure and it’s one of the leading causes of liver transplantation and young people the antidote for this is called nak or an asset eel cysteine and basically what it does is it detoxifies na p qi
And decreases the production of it it’s a very very effective antidote but it has to be given early it should be initiated within eight hours of the ingestion so this is very important you can’t wait around to see if the patient is gonna have manifestations of liver failure you need to initiate treatment based on your clinical suspicion so there’s a nomogram
That helps guide our decision about whether to give nak to patients with acetaminophen overdoses note that the nomogram doesn’t start until four hours after the ingestion so it takes four hours for gi absorption to be complete meaning we don’t check a level until four hours after the ingestion after that point depending on what level we get we can differentiate
Between high risk of toxicity and low risk of toxicity and if the patient is above that threshold for toxicity we want to go ahead and treat them all right so obviously i couldn’t cover every possible poisoning so i tried to give you some essential principles it’s really important to know your toxic drums so that you can recognize what drug class your patient
Might have been exposed to and narrow your differential diagnosis otherwise you’re going to be left trying to figure out the individual properties of lots of different drugs which is not really realistic you want to make sure you externally decontaminate your patient in order to protect you both yourself and them you want to provide aggressive supportive care
With a real focus on the abcs you want to recognize any potential high toxicity or high lethality ingestion x’ and get help you want to consider gi contempt decontamination especially in patients with a high risk of morbidity or mortality from their toxic ingestion but remember to always protect their airway when you do that and then you want to be aware of
Antidotes and use them when they’re available and indicated you
Transcribed from video
Acetaminophen (Paracetamol) Overdose – Emergency Medicine | Lecturio By Lecturio Medical