Indian Journal of Forensic Medicine & Toxicology

Open Access Open Access  Restricted Access Subscription Access
Open Access Open Access Open Access  Restricted Access Restricted Access Subscription Access

Management of Paracetamol Poisoning-the Old and the New


Affiliations
1 Department of Pharmacology, Father Muller Medical college, Mangalore, India
     

   Subscribe/Renew Journal


Paracetamol is involved in a large proportion of accidental exposures and deliberate self-poisoning cases, although subsequent hepatic failure and death are both uncommon outcomes. The optimal management of most patients with paracetamol overdose still remains unclear. The following article attempts to compile management advice with current clinical toxicology practice, revised guidelines and recent advances.

Keywords

Acetaminophen, N acetyl cysteine
Subscription Login to verify subscription
User
Notifications
Font Size


  • Buckley N, Eddleston M. Paracetamol (acetaminophen) poisoning. Clin Evid 2005; (14): 1738-1744.

  • Dart RC, Erdman AR, Olson KR, et al. Acetaminophen poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila) 2006; 44: 1-18.

  • Linden CH, Rumack BH. Acetaminophen overdose. Emerg Med Clin North Am 1984; 2: 103-119.

  • Hawton K, Ware C, Mistry H, Hewitt J, Kingsbury S, Roberts D, Weitzel H. Paracetamol selfpoisoning: characteristics, prevention and harm reduction. Br J Psych 1996; 168:43–8.

  • Ott P, Dalhoff K, Hansen PB, Loft S, Poulsen HE. Consumption, overdose and death from analgesics during a period of over-the-counter availability of paracetamol in Denmark. J Int Med 1990; 227:423–8.

  • Gow PJ, Smallwood RA, Angus PW. Paracetamol overdose in a liver transplantation centre: An 8- year experience. J Gastroenterol Hepatol 1999; 14:817–21.

  • S. B. Lall , R. Paul. Paracetamol poisoning in children.Indian Journal of Pediatrics Volume 65, Number 3, 393-400

  • V anatharaman.Paracetamol poisoning.Singapore Medical Journal 1993;Vol 33:292-294

  • Dargan PI, Jones AL. Should a lower treatment line be used when treating paracetamol poisoning in patients with chronic alcoholism?: a case against. Drug Saf 2002; 25: 625-632.

  • Rossi S, editor. Australian medicines handbook. Adelaide: Australian Medicines Handbook, 2006.

  • Buckley NA, Whyte IM, O’Connell DL, Dawson AH. Activated charcoal reduces the need for Nacetylcysteine treatment after acetaminophen (paracetamol) overdose. J Toxicol Clin Toxicol 1999; 37: 753-757.

  • Buckpitt AR,Rollins DE,Mitchell JR.Varying effects of sulfahydryl nucleophiles on acetaminophen oxidation and sulfahydryl adduct formation.Biochem Pharmacol 1979;28:2941-6

  • Harrison PM, Wendon JA, Gimson AES, Alexander GJM, Williams R. Improvement by acetylcysteine of hemodynamics and oxygen transport in fulminant hepatic failure. N Engl J Med 1991;324:1852–7.

  • Devlin J, Ellis AE, McPeake J, Heaton N, Wendon JA, Williams R. N-acetyl-cysteine improves indocyanine green extraction and oxygen transport during hepatic dysfunction. Crit Care Med 1997;25:236–42.

  • Prescott LF, Illingworth RN, Critchley JA, et al. Intravenous N-acetylcystine: the treatment of choice for paracetamol poisoning. Br Med J 1979; 2: 1097-1100

  • Little M, Murray L, McCoubrie D, Daly FFS. A potentially fatal prescribing error in the treatment of paracetamol poisoning. Med J Aust 2005; 183: 535-536.

  • Hershkovitz E, Shorer Z, Levitas A, Tal A. Status epilepticus following intravenous Nacetylcysteine therapy. Isr J Med Sci 1996;32: 1102–1104.

  • Sung L, Simons JA, Dayneka NL. Dilution of intravenous N-acetylcysteine as a cause of hyponatremia. Pediatrics 1997;100:389–91.

  • Appelboam AV, Dargan PI, Knighton J. Fatal anaphylactoid reaction to N-acetylcysteine: caution in patients with asthma. Emerg Med J 2002;19:594–5. [PubMed: 12421803]

  • Laura P. James, Philip R. Mayeux and Jack A. Hinson.Acetaminophen induced hepatotoxicity. Drug Metabolism and Disposition.December 2003 vol. 31no. 12 1499-1506

  • Tamara R. Knight, Angela Kurtz, Mary Lynn Bajt, Jack A. Hinson. Vascular and Hepatocellular Peroxynitrite Formation during Acetaminophen Toxicity: Role of Mitochondrial Oxidant Stress. Toxicol. Sci. (2001) 62 (2): 212-220.

  • H. Najafzadeh, A. Rezaie, A.M. Masoodi, and S. Mehrzadi. Comparison of the effect of vanadium and deferoxamine on acetaminophen toxicity in rats. Indian J Pharmacol. 2011 Jul-Aug; 43(4): 429–432.


Abstract Views: 222

PDF Views: 0




  • Management of Paracetamol Poisoning-the Old and the New

Abstract Views: 222  |  PDF Views: 0

Authors

Natasha Jayaprakash Nambiar
Department of Pharmacology, Father Muller Medical college, Mangalore, India

Abstract


Paracetamol is involved in a large proportion of accidental exposures and deliberate self-poisoning cases, although subsequent hepatic failure and death are both uncommon outcomes. The optimal management of most patients with paracetamol overdose still remains unclear. The following article attempts to compile management advice with current clinical toxicology practice, revised guidelines and recent advances.

Keywords


Acetaminophen, N acetyl cysteine

References