Citation

Rump LC, Keller E. Intensivmedizin und Notfallmedizin 1994; 31(1): 6-11.

Copyright

(Copyright © 1994)

DOI

unavailable

PMID

unavailable

Abstract

Paracetamol poisoning, either by accidental overdosing or by suicidal intent, is, in contrast to reports from Anglo-American countries, rare in Germany. The clinical picture is dependent on the ingested dose of paracetamol and is characterized by mild to severe liver damage, sometimes causing fulminant hepatic failure. The risk of liver damage and the decision to initiate therapy is related to the ingested dose (>150 mg/kg) and, more reliably, to the plasma concentrations of paracetamol (4-h and 12-h value). Alcohol abusers and patients taking drugs known to induce hepatic enzymes are more susceptible to hepatotoxicity. Within 4 to 8 h after ingestion of paracetamol gastric lavage followed by oral charcoal is recommended. Elimination of paracetamol by hemoperfusion should be considered only when plasma concentrations are excessively high and the time after ingestion is very short. High-dose acetylcysteine given either intravenously or orally is the therapy of choice within 36-48 h after ingestion of paracetamol. Renal failure is a more or less frequent complication of paracetamol overdosage and only in these cases should hemodialysis be commenced. Recently, prognostic parameters have been established to guide the decision for liver translantation. The case of a female patient having taken 142 g of paracetamol over a period of 48 to 60 h is presented. The plasma concentration of paracetamol measured at least 12 h after the last ingestion was still 136 μg/ml. An intravenous therapy with acetylcysteine was initiated, but fulminant hepatic failure could not be prevented. On the fifth day after poisoning there was a liver available for transplantation, but due to further complications of hepatic failure (septic condition, ileus and ARDS) a transplantation was impossible. The patient died within the next 48 h.

Language: de

Keywords

human; suicide; liver failure; hemodialysis; liver transplantation; drug overdose; glutathione; intoxication; review; paracetamol; activated carbon; antidote; acetylcysteine; intravenous drug administration; hemoperfusion; hepatic failure; methionine; paracetamol (acetaminophen) poisoning