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Paracetamol poisoning can occur accidentally or as an attempt to die by suicide. Risk factors for toxicity include alcoholism, malnutrition, and the taking of certain other hepatotoxic medications. [1] Liver damage results not from paracetamol itself, but from one of its metabolites, N-acetyl-p-benzoquinone imine (NAPQI). [6]
This is the most common type of drug-induced liver cell necrosis where the injury is largely confined to a particular zone of the liver lobule. It may manifest as a very high level of ALT and severe disturbance of liver function leading to acute liver failure. Causes include: Paracetamol, carbon tetrachloride
The LiMAx test (maximum liver function capacity) is a dynamic liver function test based on the metabolism of 13 C-methacetin by the liver-specific cytochrome P450 1A2 system. The test can be carried out at bedside displaying actual liver function at the point of measurement ( Point-of-care testing ).
Paracetamol is also often used in patients who cannot tolerate NSAIDs like ibuprofen. [36] [37] Chronic consumption of paracetamol may result in a drop in hemoglobin level, indicating possible gastrointestinal bleeding, [38] and abnormal liver function tests. The recommended maximum daily dose for an adult is three to four grams.
NAPQI, also known as NAPBQI or N-acetyl-p-benzoquinone imine, is a toxic byproduct produced during the xenobiotic metabolism of the analgesic paracetamol (acetaminophen). [1] It is normally produced only in small amounts, and then almost immediately detoxified in the liver.
for liver transplantation in acute liver failure [25] Patients with paracetamol toxicity. pH < 7.3 or Prothrombin time > 100 seconds and serum creatinine level > 3.4 mg/dL (> 300 μmol/L) if in grade III or IV encephalopathy. Other patients. Prothrombin time > 100 seconds or Three of the following variables: Age < 10 yr or > 40 years; Cause ...