Hello welcome this video is about acetaminophen toxicity acetaminophen is commonly used to over-the-counter medicine for pain and fever control in most countries though it is safe when taking it recommended doses but when taking at higher doses it can cause significant damage to liver and can lead to liver failure you four grams of acetaminophen in a 24-hour period
Is the maximum recommended dose at seven point five to 10 grams of single injection acetaminophen toxicity might occur depending on other clinical factors with ingestion of greater than 10 grams of acetaminophen the risk of toxicity increases and at 15 grams acetaminophen toxicity is most likely to happen acetominophen when ingested which is gastrointestinal tract
And gets absorbed completely then it reaches liver where most of it get metabolized to sulfate in a blue coronary conjugates minimal amount of acetaminophen with the help of cytochrome p450 gets metabolized to end a pq i which is toxic to liver at therapeutic doses this is metabolized to non-toxic substances by hepatic potassium all this happens at therapeutic
Doses now please watch what happens at toxic doses you this guide took 20 grams of acetaminophen and is wondering what’s going to happen to him on day 1 patients can be asymptomatic but nausea vomiting and i afford can occur between 1 to 3 days initial symptoms resolved ast and alt levels rise that will be right upper quadrant pain increased pt and total bilirubin
Can occur and there can be oliguria and deranged internal function between 3 to 4 days patients can develop hypoglycemia ast and alt levels peak there can be jaundice hepatic encephalopathy with increased ammonia can occur patients can also develop acute renal failure due to atm death can occur during this stage after 4 days of the patient survive recovery phase
Begins labs take several weeks to come back to normal complete recovery without chronic sexual a is expected this guide took high doses of acetaminophen at 3 p.m. acetaminophen levels should be checked after four hours after single acute condition so in this case it would be 7 p.m. treatment should be initiated if acetaminophen level is above the treatment line in
Modified rumor matthieu treatment nomogram activated charcoal can be given up to 4 hours after taking acetaminophen and it should not be given in patients who are unresponsive and acetylcysteine is the antidote for acetaminophen toxicity it should be given if acetaminophen level is above the treatment line in nomogram after four hours after acute ingestion ne se
Also should be given if time of ingestion is not known while awaiting for lab results and it should be continued if on labs acetaminophen concentration is high or if there is liver injury it also needs to be started if lab results are going to be delayed for more than 8 hours after ingestion as it is beneficial to start an es e within eight hours after ingestion
Any si should be started with the history of high doses of acetaminophen in addition and there is liver injury on labs nesc can be given orally and it is given for 72 hours commonly used in u.s. it also can be given intravenously for 20 hours commonly used in uk iv treatment is also used if oral any ac is contraindicated look at acetaminophen level it should be
Zero or near zero before any ac is stopped alt level should be significantly coming down and clinical conditions should also be improving apart from the numbers alone and finally inr should be less than two if patient goes into fulminant hepatic failure then nac should be continued until patient improves or until patient gets liver transplant if patient is in the
Transplant list during this stage serum bicarbonate and creatinine along with all of these and inr should be frequently monitored and thank you for watching this video
Transcribed from video
Acetaminophen Toxicity By mymedplanet
