Paracetamol poisoning

Paracetamol is considered as a popular over the counter medicine used as a pain killer. The normal dose is 2 tablets 6 hourly which will be add up to maximum of 8 grams  per day. But if somebody take more than 10grams, it will lead to fatal liver failure condition. Paracetamol is considered as a hepatotoxic drug when it is used exceeding the limits.
However what happens when somebody takes paracetamol overdose would be like this. Paracetamol will be metabolized into 3 metabolites where one of them is extremely toxic to the liver.This is called N-Acetyl Benzoquinomine (NAPQI). The body naturally has sufficient amount of enzyme called glutathione to eliminate NAPQI with urine when it comes to the normal dose(maximum of 4 grams). But if there was any extra amount  it will not be eliminated from the liver due to lack of sufficient glutathione. This can be very toxic to the liver and will finally lead to acute liver failure.
                   A person who take paracetamol for suicide purposes will not find anything happen to them in the first 24 hours.(Even though this is the time period that can save the patient, with antidotes) After 24 hours the drug will be absorbed into the blood and start destroying the liver cells. Within 3 days many patients turned into yellow and they have constant vomiting with severe abdominal pain.And then they die with acute liver failure.
    There are 2 antidotes that can save a patient who is hospitalized within 24 hours.

• N-Acetyl Cysteine Inj
• Methionine Powder- orally (should be given within 8 hours)

N-Acetyl Cysteine will act as glutathione and will bind with NAPQI to eliminate the toxic chemical with urine. But note that this treatment is not effective after 24 hours.

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