Paracetamol Poisning

[Acetaminophen]
Expert Omar Zourob
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Mol. Mass :151.17 g/mol

N-(4-hydroxyphenyl)ethanamide N-(4-hydroxyphenyl)acetamide (APAP) acetyl-para-aminophenol.

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Introduction: Paracetamol or acetaminophen is a widely used over-the-counter analgesic (pain reliever) and antipyretic (fever reducer). It is used for the relief of headaches and other minor aches and pains.

It is a major ingredient in numerous cold and flu remedies.

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Introduction: In combination with opioid analgesics, paracetamol can also be used in the management of more severe pain. The start of analgesia (after oral administration ) is approximately 11 minutes of paracetamol, and its half-life is 14 hours.
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Introduction: Safe doses (1,000 mg per single dose and up to 3,000 mg per day for adults (up to 2,000 mg per day if drinking alcohol).

Acute overdoses of paracetamol can cause potentially fatal liver damage .

The risk is increased by alcohol consumption.

Introduction:

Paracetamol hepatotoxicity is the most common cause of acute liver failure in both the United States and the United Kingdom. Paracetamol overdose results in more calls to poison control centers in the US.
Signs and symptoms of paracetamol toxicity may initially be absent or unclear.
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Introduction: Untreated overdose can lead to liver failure and death within days. Activated charcoal can be used to decrease absorption of paracetamol if the patient presents for treatment soon after the overdose.

While the antidote, acetylcysteine, (also called N-acetylcysteine or NAC).

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Pathophysiology
After taken orally, paracetamol is well absorbed and reaches a peak plasma concentration in one hour. It is inactivated by the liver by conjugation leading to two metabolites; glucoronide or sulfate. Then excreted through urine. Only approximately 4% of the drug is excreted unchanged.
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Pathophysiology Cytochrome P450 enzyme [CYP2E1] metabolizes another fraction (~5%) to active electrophilic TOXIC metabolite Nacetyl-p-benzoquinone imine (NAPQI).

Most of NAPQI is bound by glutathione and excreted in the urine as mercapturic acid conjugates.

Pathophysiology

Liver cell injury occurs when the amount of the toxic metabolite (NAPQI) formed exceeds the binding capacity of glutathione.
When this occurs, NAPQI reacts with nucleophilic aspects of the cell, leading to NECROSIS in the liver and in the kidney tubules.
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Glucuronyl Transferase

Sulfo Transferase

GSH Transferase

Mercapturic Acid

Necrosis

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Pathophysiology

Thank You
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