Paracetamol overdose - symptoms and consequences
Paracetamol is a medicinal product that is available in almost every home. It is used as an antipyretic and anesthetic, without thinking about the danger that this seemingly innocuous medicine conceals. After all, it can be given even to children. Hence the question arises: is it possible to poison with paracetamol?
This drug has been actively used since the middle of the XX century. It is part of a large number of drugs. And more and more often there are cases of paracetamol overdose, sometimes with a fatal outcome. Everyone should know how to avoid tragic consequences, what are the signs of poisoning and what to do in an emergency situation. We will discuss these questions below.
Than Paracetamol Is Dangerous
When paracetamol enters the body, most of the drug enters the bloodstream within the first two hours. The maximum concentration is achieved in four hours. Paracetamol is excreted bypassing the liver. Dangerous metabolites are formed under the action of a special (microsomal) enzyme system of the liver - cytochrome P-450. Neutralization is carried out with tripeptide glutathione.
If a small amount of paracetamol enters the body, then the toxic products of its metabolism are bound in the liver by glutathione and are excreted without causing harm. With excess supply of drug substance, glutathione reserves may not be enough, and metabolites begin to bind to liver proteins, which leads to their death and the appearance of symptoms of paracetamol overdose.
Metabolism products have a toxic effect on the kidneys, pancreas, heart and central nervous system. Promotes the development of acidosis (shifting the pH to the acidic side) and depression of consciousness.
The maximum daily dose of paracetamol for an adult is 4 grams, if there are liver diseases - even less. A single dose of 7.5-10 grams leads to intoxication. Deadly is a dose of 25 grams.
Causes of paracetamol poisoning:
- attempted suicide;
- the occasional administration of a large dose as a result of simultaneous application of paracetamol and the combined agents in which it is present: Citramone, Pentalgin, Caffetin, Ibuklin, Teraflu, Fervex, Rinzasip;
- combination with alcohol;
- simultaneous administration of drugs that stimulate the activity of cytochrome P-450: Phenobarbital, antihistamines, hormones, etakrinic acid;
- chronic liver disease;
- long-term use of large doses of the drug.
Symptoms of an overdose of paracetamol
There are four stages of acute poisoning.
In the first stage there are nonspecific symptoms of paracetamol poisoning. There is general malaise, nausea and vomiting. Laboratory indicators are within the normal range.
The second stage begins in a day or slightly more from the moment of taking paracetamol. During this period, signs of liver damage appear. The severity of the condition depends on the extent of the lesion. In the blood there is an increase in liver enzymes: ASAT and ALT. The indicators exceed 1000 U / l.
The third stage begins 72-96 hours later. Develops acute necrosis (death) of the liver. There are bleeding, developing hepatic encephalopathy, which can go into a coma. The activity of liver enzymes is very high and can exceed 10,000 U / L. The level of bilirubin increases, the glucose content decreases. In the blood, the concentration of lactic acid increases, the pH of the blood decreases - acidosis develops.
Symptoms of acute hepatic insufficiency:
- neuropsychiatric disorders: drowsiness, followed by motor excitement, dizziness, speech disturbance, delayed thinking, general weakness progresses, hallucinations, confused consciousness, convulsions and coma;
- dyspeptic disorders: a complete lack of appetite, a feeling of nausea, vomiting, diarrhea;
- pain in the right hypochondrium;
- there is swelling and abdominal enlargement due to fluid (ascites);
- bleeding: subcutaneous hemorrhage, nasal bleeding, bleeding gums;
- jaundice and fever, a harbinger of coma is hypothermia (lower body temperature lower than normal);
- specific hepatic odor;
- decrease in liver size;
- heart rhythm disorder;
- multiple organ failure.
Death as a result of an overdose of paracetamol can occur on day 3-5. Causes of death: failure of all organs and systems, bleeding, edema of the brain or sepsis.
The fourth stage is recovery. Due to the fact that the liver has the ability to regenerate, its rapid recovery occurs. This period can take up to several weeks.
Diagnosis of poisoning
If there is a suspicion of an overdose - it is necessary to investigate the level of paracetamol in the blood. To determine the need to use an antidote, use the Rumaka-Matthew nomogram, which allows you to predict the severity of lesions of the hepatic tissue.
The test is done 4 hours after the medication has entered the body. To do this, you need to know the exact time of poisoning. If there are no clinical manifestations and the concentration is less than 150 μg / ml, then there is no danger. With a higher content of a toxic substance, the risk of liver damage is very high and an immediate introduction of an antidote is required.
If the content of paracetamol is dangerous, then daily monitor the level of liver enzymes, bilirubin, glucose, blood coagulability.
First aid and treatment
As in any emergency, you need to know exactly what to do with an overdose of paracetamol. If there are suspicions of taking a large dose of drug, then you need to do the following.
- Rinse the stomach using a large amount of water.
- Take activated charcoal, the dose of which depends on the body weight, approximately 1 tablet per 10 kilograms of weight. This will prevent further absorption of the toxic substance.
- Call for an ambulance.
The main antidote is Acetylcysteine, which is a precursor of glutathione. As a result of its introduction, toxic products of paracetamol metabolism are rendered harmless and removed from the body. The optimal time for taking the drug is the first 8 hours.
An antidote is taken orally or in the form of intravenous infusions. The initial dose for oral administration (through the mouth) is 140 mg / kg body weight. After that every 4 hours take a dose of 2 times less. To improve taste, the drug can be diluted in a 1: 4 ratio with juice or carbonated beverage.
For infusion therapy (injection) Acetylcysteine is diluted in 200 ml of 5% glucose or saline solution. The initial dose is 150 mg / kg of body weight, after which the treatment is continued in smaller doses for 16 hours.
In mild cases, you can use Methionine, which is also a source of glutathione. It is taken by mouth at intervals of 4 hours and 2.5 grams.
With the development of severe hepatic insufficiency, symptomatic treatment is performed:
- detoxication therapy: plasmapheresis, hemosorption, hemodialysis;
- to improve microcirculation, metabolism, restore electrolyte balance and eliminate acidosis intravenously administered solutions of glucose, albumin, rheopolyglucin, gemodeza;
- To avoid edema of the brain against the background of infusion therapy, Mannitol is administered;
- vitamin therapy: vitamins of group B, ascorbic acid;
- with hemorrhagic syndrome, it is advisable to administer: Vikasola, Aminocapronic acid, Etamsylate;
- in the development of severe disorders of the coagulation function of blood, plasma is poured;
- if there is such a need - prescribe antibiotics;
- To combat hypoxia, inhalation of oxygen is used.
The consequences of paracetamol overdose may be such that a liver transplant may be required to save a person's life. In mild cases, the outcome is favorable. The prognosis depends on the dose of the drug taken, the timely treatment and adequate therapy.
Features of paracetamol poisoning in children
Ironically, in children, paracetamol poisoning manifests itself much easier than in adults, especially in those whose age is less than 6 years. This is due to the peculiarities of metabolism. For a child's body, a dose of 150 mg / kg of body weight is dangerous. Signs of liver failure are extremely rare.
The principles of assisting with paracetamol overdose in children are similar. Only the doses of antidote and the amount of injected liquid differ by intravenous infusions. In mild cases, it may be treatment at home.
How to avoid paracetamol poisoning
Prevention in this case is very important if there is no desire to feel on yourself what will happen from an overdose of paracetamol.
- take medicine as prescribed by the doctor at an acceptable dose, with an interval of at least 4 hours;
- with the existing liver disease, the dose of the drug should be reduced;
- do not combine the use of paracetamol with other medications containing this substance, before using it, it is necessary to study the composition of the combined agents;
- The duration of treatment with paracetamol should not exceed five days;
- avoid alcohol and drugs that increase the metabolism of paracetamol;
- medicines should be inaccessible to children.
Summing up, we can conclude that everything is good in moderation. Even the usual medicine can cause irreparable harm to health. Do not prescribe yourself a treatment, always seek advice from a doctor!