Drugs and Medicines
Diagnosis and Treatment of Paracetamol Hepatotoxicity
Diagnosis
In the initial treatment is crucial to try to determine the dose ingested and the time of evolution. When ingestion is to commit suicide, you should look for the presence of other toxic substances concurrently.
After an overdose, blood levels should be measured between 4 and 24 hours of ingestion. Levels drawn before 4 hours is not reliable for decision making. The value obtained should be assessed according to the Rumack-Matthew nomogram.
The diagnosis of chronic toxicity of paracetamol use is much more difficult because the symptoms are more insidious presentation and the fact of drug intake is not always obtained in the initial evaluation. Hepatotoxicity should be suspected when a patient with paracetamol risk factors (alcohol, fasting, use of inducers of cytochrome P450) has taken more than 4 g in a period of 24 h. Read the rest of this entry »
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Paracetamol Hepatotoxicity
Paracetamol was introduced a half century ago, considered a safe and effective analgesic. However, since the first report of hepatotoxicity in 1966, has accumulated considerable knowledge about its pathogenesis and treatment. At present, the toxicity is a significant cause of poisoning mortality in many countries. The prognosis depends significantly from its early recognition and initiation of specific therapeutic measures early.
Pharmacokinetics
The therapeutic dose of paracetamol is 10 to 15 mg / kg in children and 250 to 1000 mg in adults, with the maximum recommended dose 80 mg / kg in children and adults 4 g per day. The minimum toxic dose is 150 mg/kg to 10 g for children and adults, but this dose may vary depending on the basal levels of glutathione and other factors. Paracetamol is rapidly absorbed, reaching maximum plasma concentrations within 2 hours of ingestion. The therapeutic plasma concentration is 10 to 20 mg/mL. The half-life of paracetamol is 2 to 4 hours. Read the rest of this entry »