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Paracetamol (Acetaminophen) Poisoning

High-dose paracetamol intake can lead to fatal liver failure; early N-acetylcysteine treatment is life-saving.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Acil Servis department. Book Appointment →

What is Paracetamol (Acetaminophen) Poisoning?

Paracetamol (acetaminophen), although a safe analgesic and antipyretic at therapeutic doses, leads to accumulation of the hepatotoxic metabolite NAPQI at toxic doses (>150 mg/kg in adults or single intake >7.5 g).

When glutathione reserves are depleted, NAPQI causes hepatocyte necrosis, acute liver failure and risk of death. NAC acts as a glutathione precursor.

The Rumack-Matthew nomogram (paracetamol level at 4 hours) is used in treatment decisions. NAC therapy started before 8-10 hours prevents hepatotoxicity.

Symptoms

Mild nausea-vomiting and loss of appetite in the first 24 hours
Right upper quadrant pain at 24-72 hours
Elevated transaminases
Jaundice, coagulopathy
Fulminant liver failure at 72-96 hours
Hypoglycemia, metabolic acidosis
Encephalopathy

Risk Factors

Suicidal mass ingestion
Chronic alcohol use
Liver enzyme inducers such as isoniazid, phenytoin
Malnutrition
Chronic liver disease
Wrong dose in a child
Unawareness of combination products

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Go to the emergency department immediately after a toxic dose of paracetamol
  • It is a race against time even without symptoms
  • You may have inadvertently taken combined cold-and-flu products
  • If suicidal thoughts are present, also seek mental health emergency services

Treatment Methods

01
Determining the time and amount of intake
02
Paracetamol level and liver tests at 4 hours
03
Decision to start NAC according to the Rumack-Matthew nomogram
04
IV NAC protocol (150 mg/kg loading, followed by maintenance doses)
05
Activated charcoal (within the first hour)
06
Referral to a transplant center in fulminant failure
07
Psychiatry consultation (in suicide attempts)

Which Department to Visit?

You can visit our Acil Servis department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Acil Servis Department

Let us help you

You can make an appointment with our specialists or contact us for your concerns.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.