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Along with the increase in the use of paracetamol, cases of poisoning with this drug began to be noted. In 1966, the first case of massive liver damage due to paracetamol overdose was registered and described.
After oral administration, paracetamol is well and completely absorbed from the gastrointestinal tract in the small intestine, reaching the maximum concentration in the blood serum 30-60 minutes after administration. The biological half-life is 1,5-2,5 hours and is dependent on individual variability and the time of day. In the morning it is about 15 percent. greater than the half-life measured in the afternoon. About 4-5 percent. At the therapeutic dose, it is metabolized to a toxic metabolite (N-acetyl-p-benzoquinimine) which is immediately bound by glutathione to give non-toxic mercaptan. The reserve of glutathione in the liver of an adult is usually sufficient to inactivate toxic metabolites formed after ingestion of a dose of 10 g of paracetamol. Below this critical dose, which, however, shows considerable individual fluctuations, paracetamol is considered a relatively safe drug.
Children do not metabolize or hardly metabolize paracetamol to toxic compounds, hence it can be administered to them successfully and with a high degree of safety. Children are 6 times less likely to damage the liver than adults.
Note: You should never take several different drugs that contain paracetamol. This may cause the toxic dose to be exceeded.
Contraindications to the use of paracetamol
Severe impairment of liver and kidney functions, jaundice, drug allergy, hypertension, G-6 PD deficiency (red blood cells contain too little reduced glutathione; this deficiency may be exacerbated by paracetamol, so in some people with this genetic defect, paracetamol may cause haemolytic anemia), with caution in the first trimester of pregnancy.
Side effects The use of paracetamol in therapeutic doses occurs very rarely. However, it may cause side effects such as multiform skin rashes, reddening of the skin, angioedema, hypothermia, respiratory distress, bronchospasm, disturbance of the peripheral circulation, including shock.
In people suffering from gastric and duodenal ulcers, paracetamol can be used due to the lack of damaging effects on the gastric mucosa. It crosses the placenta, the fetal liver is unable to metabolize paracetamol, which poses a risk of poisoning the fetus in overdose in pregnant women. There are no reports of teratogenic (harmful to the fetus) and carcinogenic effects.
Symptoms and course of paracetamol poisoning can be presented in 4 stages.
Stage I occurs about 1/2 hour after consumption and lasts up to 24 hours. Appear: nausea, vomiting, anorexia, malaise, profuse sweating, pale skin. In most people, after undergoing gastrointestinal disturbances, the symptoms of poisoning disappear completely and no liver damage develops.
Stage II24–48 hours after ingestion – pain in the right hypochondrium area, acute renal failure begins.
Stage III, 72-96 hours after ingestion – progressive liver damage, hepatic encephalopathy, vomiting, yellowing of the skin integuments, pain in the right hypochondrium, confusion, hand tremors, impaired consciousness, hepatic coma, metabolic acidosis, hypoglycaemia, renal tubular damage, renal failure, disorders heart rhythm, hypoxia, damage to the heart muscle, hemorrhagic pancreatitis, anaphylactic reactions: urticaria, bronchospastic contraction, shock.
Stage IV, 4 days – 2 weeks after consumption – recovery phase. If no death occurs in the first 4 days of acute poisoning, the symptoms occurring in the third stage slowly regress and the patient completely recovers. Liver damage goes back up to several weeks.
Toxic effect of paracetamol on other systems and organs
Kidneys: renal failure (kidney damage may be independent of liver damage and other functional disorders, e.g. hypotension).
The circulatory system: damage to the heart muscle, arrhythmias, subendocardial bleeding (secondary to liver damage).
Pancreas: toxic hemorrhagic pancreatitis (much more common in people who abuse alcohol).
Paracetamol poisoning – first aid
Inducing vomiting in conscious people and, if there are no other contraindications, is used as the first premedical treatment. Note: Immediately transfer the patient to hospital.
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