Paracetamol Kabi Overdosage

At particular risk for hepatic damage (including fulminant hepatitis, hepatic failure, cholestatic hepatitis, cytolytic hepatitis) are elderly patients, young children, patients with hepatic disorders, chronic alcoholism, chronic malnutrition and patients concurrently receiving medicinal products that lead to enzyme induction. In such cases, overdose may be fatal.
Symptoms of overdose: Symptoms generally appear within the first 24 hours and comprise: nausea, vomiting, anorexia, pallor and abdominal pain.
Overdose with 7.5 g or more of paracetamol in a single administration in adults or 140 mg/kg of body weight in a single administration in paediatric patients, leads to hepatic cell necrosis, which can cause complete and irreversible necrosis and subsequently hepatocellular insufficiency, metabolic acidosis and encephalopathy. This, in turn, can lead to coma, sometimes with fatal outcome. Simultaneously, increased levels of hepatic transaminases (AST, ALT), lactate dehydrogenase and bilirubin in combination with decreased prothrombin levels are observed, which may occur 12 to 48 hours after administration.
Clinical symptoms of hepatic damage are usually evident after two days, and reach a maximum after 4 to 6 days.
Treatment of overdose: Immediate hospitalisation.
Before initiating treatment, and as soon as possible following the overdose, a blood sample for determination of plasma paracetamol levels should be taken.
The treatment includes administration of the antidote, N-acetylcysteine (NAC) either by the intravenous or the oral route, if possible during the first 10 hours. N-acetylcysteine can also offer some degree of protection even after 10 hours, but in this case prolonged treatment will be required.
Symptomatic treatment.
Liver function tests must be carried out at the beginning of treatment and repeated every 24 hours. Usually hepatic transaminases return to normal in one to two weeks with full recovery of normal liver function. In very severe cases, however, liver transplantation may be necessary.
Haemodialysis can reduce the plasma paracetamol concentration, but the effects are limited.