Paracetamol / Acetaminophen Update. Dr Angela Chiew – Australian Clinical Toxicologist and Emergency Staff Specialist
Paracetamol is a hard overdose to understand. There I said it. I'm no longer going to feel bad when I have to sit down and work this one out.
Acetaminophen or Paracetamol Overdose was the first illustration where I chose to anthropomorphise an organ...and so, Liver-Man was born!
A case of paracetamol-induced hepatotoxicity with a discussion of the Schiodt scoring system for predicting paracetamol-induced liver failure.
You are called by a doctor in a remote hospital asking for advice. The doctor is concerned about the risk of hepatotoxicity from repeated supratherapeutic ingestion (RSI) of paracetamol in the following patient:
Paracetamol (acetaminophen, APAP) is an ubiquitous analgesic and antipyretic agent; its safety and efficacy in critical illness?
Acute Paracetamol Toxicity: following overdose glucuronidation and sulphation pathways are rapidly saturated -> increased metabolism to NAPQI (N-acetyl-P-benzoquineimine); glutathione is required to inactivate NAPQI and when levels depleted -> hepatocellular death takes place
Paracetamol (acetaminophen): simple analgesic and antipyretic - not an NSAID as it lacks significant anti-inflammatory effects
Our American ER doc gone walkabout struggles with medications, millimoles and the metric system in the emergency medicine nirvana that is Tasmania...