The third phase follows at 3 to 5 days, and is marked by complications of massive liver necrosis leading to fulminant liver failure with complications of coagulation defects, low blood sugar, kidney failure, hepatic encephalopathy, brain swelling, sepsis, multiple organ failure, and death. In these cases, it has been suggested that the toxic metabolite is produced more in the kidneys than in the liver. In some cases, acute kidney failure may be the primary clinical manifestation of toxicity. Acute kidney failure may also occur during this phase, typically caused by either hepatorenal syndrome or multiple organ dysfunction syndrome. The increasing liver damage also changes biochemical markers of liver function International normalized ratio (INR) and the liver transaminases ALT and AST rise to abnormal levels. The individual may experience right upper quadrant abdominal pain. In general, damage occurs in liver cells as they metabolize the paracetamol. The second phase occurs between 24 hours and 72 hours following overdose and consists of signs of increasing liver damage. Rarely, after massive overdoses, patients may develop symptoms of metabolic acidosis and coma early in the course of poisoning. However, patients often have no specific symptoms or only mild symptoms in the first 24 hours of poisoning. The first phase begins within hours of overdose, and consists of nausea, vomiting, a pale appearance, and sweating. The signs and symptoms of paracetamol toxicity occur in three phases. In the United States and the United Kingdom, paracetamol is the most common cause of acute liver failure. Young children are most commonly affected. In the United Kingdom it is the medication responsible for the greatest number of overdoses. In the United States more than 100,000 cases occur a year. Rates of poisoning vary significantly between regions of the world. Paracetamol poisoning was first described in the 1960s. With early treatment liver failure is rare. The need for transplant is often based on low blood pH, high blood lactate, poor blood clotting, or significant hepatic encephalopathy. A liver transplant may be required if damage to the liver becomes severe. Psychiatric care may be required following recovery. The medication is generally given for at least 24 hours. If there is a potential for toxicity, the antidote acetylcysteine is recommended. Attempting to force the person to vomit is not recommended. Treatment may include activated charcoal if the person seeks medical help soon after the overdose. These values are often plotted on the Rumack-Matthew nomogram to determine level of concern.
Diagnosis is based on the blood level of paracetamol at specific times after the medication was taken. NAPQI decreases the liver's glutathione and directly damages cells in the liver. Liver damage results not from paracetamol itself, but from one of its metabolites, N-acetyl- p-benzoquinone imine (NAPQI).
Risk factors for toxicity include alcoholism, malnutrition, and the taking of certain other hepatotoxic medications. Paracetamol poisoning can occur accidentally or as an attempt to die by suicide. Without treatment, death from toxicity occurs 4 to 18 days later. If death does not occur, people tend to recover fully over a couple of weeks. Additional complications may include kidney failure, pancreatitis, low blood sugar, and lactic acidosis. This is typically followed by a couple of days without any symptoms, after which yellowish skin, blood clotting problems, and confusion occurs as a result of liver failure. These include feeling tired, abdominal pain, or nausea. Most people have few or non-specific symptoms in the first 24 hours following overdose. Paracetamol poisoning, also known as acetaminophen poisoning, is caused by excessive use of the medication paracetamol (acetaminophen). Paracetamol (acetaminophen) usually > 7 g Īlcoholism, malnutrition, certain other hepatotoxic medications īlood levels at specific times following use Īlcoholism, viral hepatitis, gastroenteritis Īctivated charcoal, acetylcysteine, liver transplant Liver failure, kidney failure, pancreatitis, low blood sugar, lactic acidosis. Later: Yellowish skin, blood clotting problems, confusion Acetaminophen toxicity, paracetamol toxicity, acetaminophen poisoning, paracetamol overdose, acetaminophen overdose, Tylenol toxicityĮarly: Non specific, feeling tired, abdominal pain, nausea
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