Poisoning from - paracetamol
Description
- Commonest pharmaceutical overdose and the commonest cause of acute liver failure in Australia and the UK
- Asymptomatic in the first 24 h - the antidote must be given before any clinical sign appears
- Treatment decisions rest entirely on dose, timing and level - never on how the patient looks
Ingestion patterns - each has its own pathway
| Pattern | Definition |
|---|---|
| Acute | All ingested within an 8-hour window |
| Staggered | Multiple ingestions over >8 h with intent to self-harm |
| Repeated supratherapeutic (RSTI) | Excess taken over time for therapeutic purpose |
| Modified-release (Panadol Osteo) | Separate algorithm - delayed and prolonged absorption |
| IV paracetamol | Dosing errors, especially <50 kg and paediatrics |
Phases
- I (0-24 h) - asymptomatic or nausea/vomiting, malaise
- II (24-72 h) - RUQ pain, transaminases rise, INR rises
- III (72-96 h) - peak hepatotoxicity: jaundice, encephalopathy, coagulopathy, lactic acidosis, AKI, hypoglycaemia
- IV (4 d-2 wk) - recovery, complete if survived
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