Acute poisoning of the fever-reducing drug acetaminophen

The article is written by Master - Doctor Le Van Binh - Doctor of Intensive Care Department - Vinmec Times City International General Hospital.

Acetaminophen is a widely used antipyretic and pain reliever because it is safe, but can cause poisoning when overdosed or suicide.

1. Toxic Dose of Acetaminophen

Maximum concentration at the 4th hour. After oral administration, Acetaminophen overdose is metabolized in the liver to toxic substances, reduced Glutathione and necrosis of hepatocytes. Acetaminophen toxic dose > 150mg/kg.

2. Diagnosis of acute poisoning of the antipyretic drug acetaminophen

2.1 Clinical diagnosis

History: Acetaminophen overdose > 150mg/kg. Before 24 hours: Anorexia, vomiting, abdominal pain. After 24-72 hours: Vomiting, elevated liver enzymes, prolonged PT. From 72 to 96 hours: Hepatocellular necrosis, jaundice, liver failure, encephalopathy - liver disease, coagulopathy, acute renal failure, multi-organ failure. From day 4 to 2 weeks: Progressive or reversible liver failure.

Suy gan — Sử dụng quá liều thuốc acetaminophen có thể gây suy gan

2.2 Determining the diagnosis of acute poisoning with the antipyretic drug acetaminophen

History: Acetaminophen overdose > 150mg/kg. Clinical: Anorexia, vomiting, abdominal pain. Jaundice, enlarged liver. Test: Quantify Acetaminophen in the blood: Acetaminophen concentration > 140 μg/mL after the 4th hour. Or Acetaminophen concentration in the toxic hazard range.

2.3 Differential diagnosis of acute poisoning with the antipyretic drug acetaminophen

Viral hepatitis.

3. Treatment of acute poisoning with fever-reducing drug acetaminophen

Principles of treatment of poisoning with antipyretic acetaminophen are: Treatment of emergency situations; quickly remove toxins; specific antagonists and treatment of complications.

3.1 Treatment of emergency situations

Respiratory resuscitation. Resuscitate shock with fluids and vasopressors.

3.2 Elimination of toxins

Gastric lavage.
Activated charcoal:
It is necessary to give activated charcoal as soon as possible after gastric lavage. Do not give activated charcoal when taking an oral N-acetylcysteine antagonist.

Rửa dạ dày — Tiến hành rửa dạ dày loại bỏ chất độc

3.3 Specific N-acetylcysteine . antagonists

Glutathione replacement effect is lacking due to poisoning. N-acetylcysteine should be given early before the patient develops liver damage. Intravenous nutrition. Hemodialysis: although hemodialysis can remove Acetaminophen from the body, hemodialysis is usually not indicated even with high concentrations of Acetaminophen because most respond well to N-acetylcysteine. Therefore, hemodialysis is indicated in acute renal failure.

3.4 Treatment of complications

Hypoglycemia: Hypertonic glucose Electrolyte disturbances Coagulation disorders: Vitamin K1. Acute liver failure (see acute liver failure protocol).

Rối loạn đông máu — Bệnh nhân rối loạn đông máu chỉ định dùng vitamin K1

4. Follow up

Vital signs. Jaundice, liver size. Blood sugar, electrolytes. Liver ultrasound. Liver function.

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