Ronald Chrisbianto Gani

405090223
Faculty of Medicine
Tarumanagara University
EMERGENCY MEDICINE BLOCK
PARACETAMOL
POISONING
TOXICOLOGY
Drugs
Acetaminophen
Aspirin / Salicilates
Hydrocarbon
Cholinesterase Inhibitors
Theophylin
Isoniazid
Digoxin
Ephedrine
Antihistamin
Antidepressant
Antihipertensi (CCB & B-
Blocker)
Anticholinergic
Heavy Metals
Lead
Mercury
Arsenic
Steel
Food
Singkong
Jengkol
Bongkrek
Alfa-Toksin
Air pollutant
CO
SO2
O3
PARACETAMOL / ACETAMINOPHEN
POISONING
ACETAMINOPHEN
Absorbed rapidly, inhibits PGE2 synthesis
Metabolite : NAPQI, need to bind with
glutathione to be excreted
If NAPQI > gluthatione, NAPQI will bind to liver
cells liver injury, mostly in centrilobular
zone
Renal injury may also occur with-/out liver
injury.
Rosens Emergency Medicine 7th Ed
A
C
E
T
A
M
I
N
O
P
H
E
N

Rosens Emergency Medicine 7th Ed
CLINICAL FEATURES
Rosens Emergency Medicine 7th Ed
DIAGNOSIS
Risk assessment for Acute Ingestion
Determine patients risk of acute exposure
Establish time of ingestion
Determine serum acetaminopen concentration 4
hours postingestion or ASAP after 4 hours
If serum acetaminophen above the treatment line
NAC
If serum acetaminophen is below the treatment
line no NAC needed
Rosens Emergency Medicine 7th Ed
ACETAMINOPHEN
Rosens Emergency Medicine 7th Ed
DIAGNOSIS
Risk assessment for chronic ingestion
Determine if patient at risk of hepatotoxicity :
measure serum concentration and AST

Rosens Emergency Medicine 7th Ed
MANAGEMENT
Limiting GI absorbtion
Lavage : rare, because of rapid absorbtion
Activated Charcoal
N-Acetilcysteine
Given ASAP when indicated, PO or IV
If liver failure is evident : IV
Durations : 72h PO protocol or 21h IV protocol
Supportive care
Rosens Emergency Medicine 7th Ed
MANAGEMENT
Dermal exposure burns decontaminate
Wash the skin with soap and copious
lukewarm water

Rosens Emergency Medicine 7th Ed
REFERENCES
Katzung Basic & Clinical Pharmacology 11th Ed
Farmakologi dan Terapi Edisi 5
Rosen Emergency Medicine 7th Ed