SN3
SHORT NOTE
5M
Define Paracetamol Poisoning. Describe its management and prevention.
Definition
Paracetamol (acetaminophen) poisoning causes dose-dependent hepatotoxicity. In overdose, the toxic metabolite NAPQI depletes hepatic glutathione and injures hepatocytes.
Clinical Phases
| Phase | Time | Features |
|---|---|---|
| I | 0–24 h | Nausea, vomiting, malaise (or asymptomatic) |
| II | 24–72 h | Right upper quadrant pain, rising transaminases |
| III | 72–96 h | Peak hepatotoxicity — hepatic failure, encephalopathy |
| IV | 4 days–2 weeks | Recovery or death |
Management
- Assess the dose/time; use the paracetamol treatment nomogram where timing is known.
- Activated charcoal if presenting early (within ~1 hour).
- N-acetylcysteine (NAC) — the antidote (replenishes glutathione); highly effective when given early.
- Supportive care and monitoring of liver function/coagulation.
Risk Assessment
The paracetamol treatment nomogram plots the plasma level against the time since ingestion to decide on NAC; it applies to a single acute ingestion with a known time, and errs toward treating when in doubt.
Key Points Recap
- Overdose → NAPQI → glutathione depletion → hepatocyte necrosis.
- Four clinical phases; use the nomogram; NAC is the antidote (best within 8 h).
Prevention
Many paediatric emergencies are preventable — safe storage of poisons/medicines, supervision, protective measures and prompt first aid substantially reduce serious harm and mortality.
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