Grand Rounds Recap 5/4

Grand Rounds Recap 5/4

Acetaminophen Toxicity Sim - Drs. LaFollette, Nelson and Toth

Take a read through our Cases If It Bleeds it Leads..., Seeing is Believing..., and Belly Pain Bonanza. Curated commentary to follow

Acetaminophen Toxicity

  • 60,000 poisonings / year
  • ~500 deaths per year, evenly split therapeutic / suicide
  • Mechanism - acetaminophen to NAPQI by P450, overwhelming gluthathione stores
  • Alcohol, phenytoin, isoniazid all induce P450 and may increase NAPQI production. Chronic alcohol use will worsen toxicity when acute ingestion will competitively inhibit and can be preventative at producing the toxic metabolite
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Grand Rounds Recap - 10/22/14

Grand Rounds Recap - 10/22/14

Acetaminophen can be one of the most dangerous drugs in overdose, as the toxic dose of acetaminophen is 250 mg/kg

There are 4 stages of acetaminophen overdose:

  • Stage 1 from 0-24 hours when labs may be normal but the patient has nonspecific symptoms such as nausea, vomiting, and fatigue
  • Stage 2 from 24-72 hours when labs may be normal or be trending upward but the patient is asymptomatic
  • Stage 3 from 72-96 hours when significant metabolic derangement can occur such as profound metabolic acidosis, florid liver failure, and AKI.
  • Stage 4 takes place only if you are able to get them through the acute illness precipitated in Stage 3 when hopefully recovery takes place, though there is no guarantee of liver recovery
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