Paracetamol poisoning

Serious, life-threatening toxicity is likely after ingestion of >15g paracetamol, particularly with co-ingestion of enzyme-inducing drugs (e.g. anticonvulsants, anti-TB therapy) and/or alcohol.

Paracetamol is rapidly absorbed from the stomach and upper small bowel and is metabolised by conjugation in the liver. Hepatic necrosis occurs due to the toxicity of an alkylating metabolite that is normally removed by conjugation with glutathione; glutathione is rapidly depleted with overdose and may already be low in starvation, alcoholics and, possibly, HIV disease, thus predisposing these groups to an increased risk of toxicity.

Toxicity is usually asymptomatic for 1-2 days although laboratory assessment of liver function may become abnormal after 18h.

Hepatic failure, if manifest, develops after 2-7 days, an earlier onset being associated with more severe toxicity.

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