Question

Acetaminophen overdose:

A patient comes to the ED after her family found her at home with two empty bottles of acetaminophen and a note stating she no longer wished to live.

1. What do you anticipate will be ordered to help reverse the effects of the acetaminophen? Describe its mechanism of Action.

2. What will you monitor? Include laboratory studies and signs and symptoms of organ failure.

Answer 1

N- acetylcysteine is the antidotal therapy  of accetaminophen overdose. It help to reverse the effect of accetaminophen.

Supportive therapy include

IV fluids

Anti emetics medicines

Activated charcol

MECHANISM OF ACTION (N-acetylcysteine)

The mechanisms of action for acetycysteine's well known mucolytic effects are different. Inn particular, when inhaled, acetycysteine (and its metabolic byproduct cysteine) exerts its mucolytic action throgh its free sulfhydrly group, which reduces the disulfide bonds in the mucus matrix and lowers mucus viscosity.

LABORATORY INVESTIGATION

Acetaminophen toxicity is usually confirmed through diagnostic tests such as

Acetaminophen level

Electrolytes

Kidney function tests

Amylase

Lipase

Liver function tests

Complete blood count

Coagulation factors

Imagine studies such as an ultrasound to assess liver enlargement.

A liver biopsy

ASSESSMENT OF PATIENT

Vital signs monitoring every 2hourly or as needed.

Check urine out

Monitor level of consciousness

Monitor oxygen saturation.

Monitor appetite.

Monitor skin colour change.

SIGNS AND SYMPTOMS OF ORGAN FAILURE

Decresed urine output , although occasionally urine output remains normal.

Fluid retention causing swelling in your legs, ankles or feet.

Shortness of breath

Fatigue

Confusion

Weakness

Irregular heartbeat.

Overdose of accetaminophen cause acute liver failure in some patients.

Symptoms include jaundice, excessive bleeding, altered level of consciousness, hyperdynamic circulation, hepatocellular necrosis, low blood pressure.