Paracetamol (acetaminophen) poisoning

Medical Fortune‐telling: Predicting Acetaminophen Toxicity

“…4 Lowering the nomogram to a plot joining 150 g/mL at 4 hours and 30 g/mL at 12 hours (the ''possibly toxic'' line) improves the negative predictive value, but decreases the positive predictive value and leads to much unnecessary treatment while still leaving untreated some who need it. [5][6][7] Thus, we recognize that an elevated acetaminophen level plotted vs time is just one of several risk factors, rather than markers, for toxicity. Nevertheless, this method of identifying those who need antidotal therapy serves well for a single ingestion presenting early (within 16-18 hours), so long as we are willing to accept a large number of unnecessary admissions.…”

Does N-acetylcysteine improve hemodynamics and graft function in liver transplantation?

“…Copyright 1998 by the American Association for the Study of Liver Diseases N -acetylcysteine (NAC), a glutathione precursor, has a well-recognized protective effect against metabolic hepatocellular injury from acetaminophen overdose. 1 This drug acts by replenishing the stores of intrahepatic glutathione, an endogenous antioxidant. NAC has been shown to improve hemodynamics and oxygen transport in patients with fulminant hepatic failure of various etiologies and had a beneficial effect on survival.…”

Acute Liver Failure

“…19,20 Hepatotoxicity has been reported after therapeutic doses in patients who are concurrently taking enzyme-inducing drugs, such as phenytoin, and in patients who are chronic consumers of alcohol. Alcohol acetaminophen syndrome is emerging as an important cause of ALF in the United States.…”

“…[45][46][47] Acetaminophen overdose should be treated with Nacetyl cysteine. 19,20 Nanograms of serum acetaminophen levels to predict hepatotoxicity are of little value in alcoholacetaminophen syndrome because of a number of reasons: 1) time of ingestion is frequently not available; 2) ingestion usually occurs over multiple stages; and 3) hepatotoxicity can occur with therapeutic doses and low blood levels in patients with concurrent use of alcohol. 2,21,22 Mushroom poisoning caused by the species Amanita phalloides needs urgent gastric lavage and penicillin 300,000 to 1,000,000 units/kg/day intravenously in divided doses, plus silibinin (a water-soluble form of silymarin) 20 to 50 mg/kg/day intravenously.…”