DR Medhat MRCP

NB : the most helpful test in determining the outcome in paracetamol
خللي بالك : paracetamol over dose depends on the time after ingestion of
1) 4-8 hrs : paracetamol concentration.
2) 8-18 hrs : AST level
3) 18-72 hrs : ALT level
4) ≥ 72 hrs : PT/INR
B)
Staggered overdose
All patients should start NAC immediately regardless the individual risk
factors for hepatotoxicity.
All of these cases should be discussed with a medical toxicologist
Do paracetamol level ,SUE ,ALT,INR ,NaHCO3.
Hepatotoxicity is unlikely if all the following criteria are fullfiled :
1. > 24 hrs after the last ingestion of paracetamol
2. Asymptomatic patient
3. Paracetamol level < 5 mg/L.
4. INR ≤ 1.3
5. ALT < 2 times upper limit of normal.
- If all those criteria are fulifiled , NAC can be stopped & the patient can be
discharged with advice to return back if he became symptomatic (vomiting
& abdominal pain)
C)
Repeated supratherapeutic ingestion
- All patients who have taken a repeated supratherapeutic overdose of paracetamol should
be considered for treatment with NAC.
- discussion with a medical toxicologist is strongly advised.
- Treatment will depend on clinical presentation and amount of paracetamol ingested as per
algorithm below.
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