Fifteen-minute update: International normalised ratio as the treatment end point in children with acute paracetamol poisoning

Paracetamol is one of the most frequent reasons for poisonings across the UK with an estimated 90,000 patients and 150 deaths annually. International normalised ratio (INR) may be elevated due to hepatocellular damage and is frequently used to monitor progress on N-acetyl cysteine. N-acetyl cysteine is associated with reduced activity of vitamin K dependent clotting factors leading to a benign elevation of INR. In asymptomatic children with normal aspartate transaminase/alanine transaminase, isolated borderline elevation of INR following paracetamol overdose should be reviewed for possible N-acetyl cysteine induced elevation of INR. Due to these factors, in those with borderline persistent elevation of INR, N-acetyl cysteine can be safety stopped if INR is falling on two or more consecutive tests and is <3.0.

Rodenticide-induced acute liver failure – Uncommon presentation of commonly available poison

Rodenticide or ‘rat poison’ is easily available in a predominantly agrarian economy such as India. Metal phosphides or yellow phosphorous are two common rodenticides. Acute liver failure caused by accidental or suicidal poisoning with rodenticides has been infrequently reported in literature. Liver transplantation offers the best chances of survival in severe intoxication. However, the availability of liver transplantation in resource-limited settings presents a challenge. N-acetyl cysteine has been successfully used in paracetamol poisoning. Its use in rodenticide-induced acute liver failure is not so well known. We report three cases of rodenticide-related acute liver failure, one of them being a pregnant lady. All three patients were given N-acetyl cysteine and two patients improved. It is possible that the administration of N-acetyl cysteine contributed to the improvement in these two.

Large paracetamol overdose -- higher dose NAC is required

Paracetamol poisoning continues to be a worldwide problem and despite the availability of an affective antidote, N-acetylcysteine (NAC), the optimal way to use this antidote, particularly following very large doses of paracetamol, has not been established. Recent case series have shown an increased toxicity from paracetamol, even in those receiving prompt NAC therapy, at high doses of paracetamol, particularly in patients above the 300 mg/L nomogram treatment line. Clinical trial evidence supporting shorter NAC dosing now allows the possibility for intensifying treatment without the risk of very high rates of ADRs. New biomarkers also show the possibility of early identification of patients at risk of liver injury who might also benefit from increased intensity treatment. This article discusses these data and proposes a logical therapy for increasing NAC dosing which now requires clinical trial testing.

A Case of ALERD Masquerading as Paracetamol Poisoning

ALERD (Acute leukoencephalopathy with restricted diffusion) is a clinico – radiological diagnosis. Many novel causes of acute encephalopathy are emerging in children. MRI plays an important role in the diagnosis and management of such children. Many infectious and non-infectious conditions and poisonings are known to precipitate acute leukoencephalopathy. A commonly used drug like paracetamol ingested in large quantities is known to cause varied effects. We describe one such child who presented to us with paracetamol poisoning and developed acute leukoencephalopathy. He was later found to have restricted diffusion on magnetic resonance imaging.

Keracunan Parasetamol Pada Kucing Dan Anjing: Gejala Klinis dan Terapi

Acetaminophen, commonly known as paracetamol, is a non-steroidal anti-inflammatory drug commonly used in human medicine for its antipyretic and analgesic action. As paracetamol became readily available in many over-the-counter and no-prescription products, reports of paracetamol poisoning in dogs and cats became more common. The toxicity of paracetamol is more pronounced in cats when compared to dogs. Clinical signs of paracetamol toxicity include depression, weakness, tachypnea, dyspnea, vomiting, hypothermia, facial or paw edema, hepatic necrosis, and death. The characteristics of severe paracetamol poisoning are methemoglobinemia, cyanosis, anemia, and jaundice. Although there are no specific antidotes, acetylcysteine is the drug of choice for paracetamol poisoning treatment. Symptomatic and supportive therapies play a more definitive role in the management of paracetamol poisoning. This paper aims to briefly review the clinical symptoms, diagnosis, and treatment of paracetamol poisoning in dogs and cats.