Acute Poisoning - Paracetamol & Salicylates

Paracetamol

Overwhelming of body's glutathione, in its inactivation of paracetamol's toxic metabolite
Safe up to 150mg/kg
>350mg/kg = extensive damage
Hepatotoxic
Nephrotoxic
High risk - malnourished, immunocompromised, anti-epileptics, anti-TB medication, alcohol excess

Ix
Levels
Standardised Treatment Graph - normal and high risk treatment lines

Tx

N-acetylcysteine - supplies glutathione
Side-effects - wheezing, flushing hypotension, bronchospasm, anaphylactoid reation

Alternative is methionine PO (<12hrs)


Salicylates

1 tube of bonjela cream = 970mg

Ix

Levels at every 4 hrs

>500mg/L Moderate-Severe

>700mg/L Lethal

Tx
Activated charcoal
Rehydrate
>500mg/L alkaline diuresis
>700mg/L haemodialysis

Alkaline diuresis - elimination of salicylate ions increased in alkaline urine
- Optimum urine pH = 7.5-8.5
- Serum pH = upper limit at 7.6
Correct any hypokalaemia