Fulminant Liver Failure_Paracetamol Overdose

Posted by e-Medical PPT Monday, August 30, 2010
Paracetamol toxicity is caused by excessive use of the paracetamol(called acetaminophen in the United States). Mainly causing liver injury, paracetamol toxicity is one of the most common causes of poisoning worldwide.Many individuals with paracetamol toxicity do not manifest symptoms at all in the first 24 hours following overdose. Others may initially have nonspecific complaints such as vague abdominal pain and nausea. With progressive disease, signs of fulminant liver failure may develop; these include low blood sugar, low blood pH, easy bleeding, and hepatic encephalopathy. Some will spontaneously resolve, although untreated cases may result in death.
Hepatotoxicity, results not from paracetamol itself, but from one of its metabolites, N-acetyl-p-benzoquinoneimine (NAPQI).NAPQI consumes the liver's natural antioxidant glutathione and directly damages cells in the liver, leading to liver failure. Risk factors for toxicity include excessive chronic alcohol intake, fasting or Anorexia nervosa, and the use of certain drugs such as isoniazid.
Treatment is aimed at removing the paracetamol from the body and replacing glutathione. Activated charcoal can be used to decrease absorption of paracetamol if as the initial treatment soon after the overdose; the antidote acetylcysteine acts as a precursor for glutathione, helping the body regenerate enough to prevent damage to the liver. A liver transplant is often required if damage to the liver becomes severe. Patients treated early have a good prognosis, whereas patients that develop major liver abnormalities typically have a poor outcome.

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