Paracetamol Overdose
Presentation
- RUQ pain
- Nausea & vomiting
- Liver failure (NAPQI toxicity)
- Jaundice
- Encephalopathy
- Lactic acidosis
Investigations
- Paracetamol level @ 4 hrs (Rumack nomogram)
- ↑ ALT / AST
- ↑ PT/INR
- Hypoglycemia
Management
- Activated charcoal if <1 hr
- NAC if above treatment line @ 4 hrs
- NAC if staggered / unknown amount
- Liver transplant in acute liver failure
Key Concept
- NAPQI ↑ → GSH depletion → hepatic necrosis
Quick Notes:
Use Rumack-Matthew nomogram at 4 hrs. NAC works best early, but always useful. Common cause of acute liver failure.
Use Rumack-Matthew nomogram at 4 hrs. NAC works best early, but always useful. Common cause of acute liver failure.
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