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Paracetamol

Paracetamol. Why are there no aspirin in the jungle?. Actions. Good analgesic and anti-pyretic properties. Poor anti-inflammatory properties. Does not share GI side effects and therefore is often not referred to as an NSAID at all. Side Effects. Very few at therapeutic levels.

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Paracetamol

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  1. Paracetamol

  2. Why are there no aspirin in the jungle?

  3. Actions • Good analgesic and anti-pyretic properties. • Poor anti-inflammatory properties. • Does not share GI side effects and therefore is often not referred to as an NSAID at all.

  4. Side Effects • Very few at therapeutic levels. • Allergic skin reactions sometimes occur.

  5. Toxicity • Symptoms • Initially • None • Vomiting • RUQ pain • Later • Jaundice • Encephalpathy from liver damage • Renal Failure

  6. Mechanism of action oxidised conjugated by glutathione cysteine NAPQI paracetamol Toxic metabolite

  7. Management before plasma concentrations known. 1 tablet = 500mg If patient has ingested: > 12g (24 tablets) within 1hr = > 12g (24 tablets) within 8hrs = LAVAGE. ACTIVATED CHARCOAL.

  8. Management continued 4hrs • Do plasma concentrations at • If BIG OD suspected start • RASH is common. Start • DO NOT STOP • Beware falling blood glucose levels and elevated INR. ACETYLCYSTEINE. chloramphenamine. UNLESS ANAPHYLAXIS.

  9. Transfer to ITU if: • Encephalopathy or RAISED ICP • Bradycardia • Poor pupil responses • BP > 160/90 • INR > 2.0 at < 48HRs or INR > 3.5 < 72HRs • Renal failure • Acidosis

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