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Chapter-47 Paracetamol Poisoning

BOOK TITLE: IAP Textbook of Pediatric ICU Protocols

Author
1. Udani Soonu
2. Sehgal Anupam
ISBN
9789350903704
DOI
10.5005/jp/books/11878_47
Edition
2/e
Publishing Year
2013
Pages
6
Author Affiliations
1. PD Hinduja Hospital, Mumbai, Maharashtra, India, PD Hinduja National Hospital and Medical Research Center, Mumbai, e-mail: dr_sudani@hindujahospital.com, PD Hinduja National Hospital and Medical Research Centre, Mumbai; Grand Medical College, Mumbai, India, Hinduja Hospital, Mumbai, Maharashtra, India, PD Hinduja Hospital and Medical Research Center, Mumbai, Maharashtra, India, Hinduja Hospital, Mumbai, Maharashtra, PD Hinduja National Hospital and Medical Research Center, Mumbai, Maharashtra, India, PD Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India, SRCC Children’s Hospital Managed by Narayana Health, Mumbai, Maharashtra, India, SRCC Children's Hospital, Mumbai, Maharashtra, India, SRCC Children’s Hospital (Managed by Narayana Health), Mumbai, Maharashtra, India, Critical Care and Emergency Services, SRCC Children’s Hospital, Narayana Health, Mumbai, Maharashtra, India, PD Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra
2. Centre for Child Health, Sir Ganga Ram Hospital, New Delhi, Center for Child Health, Sir Ganga Ram Hospital, New Delhi., PD Hinduja Hospital, Mumbai, Maharashtra, India
Chapter keywords
Paracetamol poisoning, N-acetyl-p-benzoquinoneimine, Paracetamol intoxication, Paracetamol toxicity, N-acetylcysteine, Gastrointestinal decontamination, Activated charcoal administration, Plasma paracetamol, Rumack-Matthew nomogram

Abstract

The risk of developing toxic reactions to paracetamol is higher in adults than in children. It is the most widely used analgesic and antipyretic. A single ingestion of more than 7.5 gram of paracetamol is considered a minimum toxic dose in adolescents and adults. Its toxicity is related to the production of the reactive intermediate N-acetyl-p-benzoquinoneimine (NAPQI) by the hepatic cytochrome P450 system. Long-term treatment with paracetamol is associated with a high-risk of mortality. Paracetamol intoxication typically includes four phases. Management is by administration of N-acetylcysteine (NAC). Activated charcoal (1 g/kg) mixed with carbonated (soda) water is also administered in some cases. Management of all patients who had paracetamol after 8–15 hours and 15–24 hours by NAC administration is discussed. The correct dosage for intravenous infusion of NAC is explained in an algorithm.

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