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Hye gais.. Paracetamol Poisoning
19yo gentleman, myvi driver, attempted suicide.
allegedly took 20 tablets of PCM 5hours ago prior to presentation to ED.. He got nausea and vomiting
19yo gentleman, myvi driver, attempted suicide.
allegedly took 20 tablets of PCM 5hours ago prior to presentation to ED.. He got nausea and vomiting
Little did the patient know, PCM that he took doesnt kill him straight away. because first 48h, most pt generally well with symptoms of nausea n vomiting only.
Later baru start ada transaminitis.
After 72h baru ada severe complication mcm encephalopathy, hepatoxicity n death
Later baru start ada transaminitis.
After 72h baru ada severe complication mcm encephalopathy, hepatoxicity n death
How PCM can be fatal eh?
macam ni. 90% pcm akan conjugated dlm liver pastu excreted out dalam urine. takde masalah
Lagi 2% of pcm eliminated unchanged dlm urine. also takde masalah
yg masalah remaining 8% ni.
macam ni. 90% pcm akan conjugated dlm liver pastu excreted out dalam urine. takde masalah
Lagi 2% of pcm eliminated unchanged dlm urine. also takde masalah
yg masalah remaining 8% ni.
yang 8% ni dekat liver, dia metabolized by cytochrome P450.
Dan terhasillah sejenis bahan bernama NAPQI
NAPQI ni kalau dia bind je dekat liver cell, cell tu akan mati, last ape jadi? yes necrosis! liver necrosis tu yg bahaya
Dan terhasillah sejenis bahan bernama NAPQI
NAPQI ni kalau dia bind je dekat liver cell, cell tu akan mati, last ape jadi? yes necrosis! liver necrosis tu yg bahaya
tapi utk nomal people like you and me, dalam liver kita ada polis bernama Glutathione.
Glutathione ni dia bind dgn NAPQI tu and detoxify it away.
So NAPQI xdela suka2 serang liver cell. Sebb belum sempat NAPQI ni nk buat jenayah dah kena tangkap dgn inspektor Glutathione.
Glutathione ni dia bind dgn NAPQI tu and detoxify it away.
So NAPQI xdela suka2 serang liver cell. Sebb belum sempat NAPQI ni nk buat jenayah dah kena tangkap dgn inspektor Glutathione.
Tapi.. tapi.. tapi..
what happen kalau kita mkn PCM dlm quantity yg sgt banyak?
NAPQI automatik jadi banyak kan?
means penjenayah bnyak
so obviously polis kita Glutathione tu x menang tangan nk tangkap NAPQI tu
end up ape jadi? Massacre!
pembunuhan beramai2 liver cell
what happen kalau kita mkn PCM dlm quantity yg sgt banyak?
NAPQI automatik jadi banyak kan?
means penjenayah bnyak
so obviously polis kita Glutathione tu x menang tangan nk tangkap NAPQI tu
end up ape jadi? Massacre!
pembunuhan beramai2 liver cell
okay gais berbalik pada pt tadi.. most of the time, ni case attempted suicide. and kalau fam member bawak sarung ubat tu, you gais can double check wether its pcm or other drugs
in this case, its PCM because i said so 
so its a clear case!
Moving on, whats your plan now?
gastric lavage?
activated charcoal?
Anti-emetic?
ke drip je cukup?
Any other drugs in your mind?
so its a clear case!Moving on, whats your plan now?
gastric lavage?
activated charcoal?
Anti-emetic?
ke drip je cukup?
Any other drugs in your mind?
kena faham, bila kita nk kata its PCM poisoning?
1) kalau pt tu ambik >15 tablet (7.5g)
2) if dose pcm tu >150mg/kg body weight
3) kalau PCM level at 4H or more atas toxicity level kalau korg plot dekat Rumack-Matthew nomogram
4) ada hepatotoxicity
1) kalau pt tu ambik >15 tablet (7.5g)
2) if dose pcm tu >150mg/kg body weight
3) kalau PCM level at 4H or more atas toxicity level kalau korg plot dekat Rumack-Matthew nomogram
4) ada hepatotoxicity
basically ada je salah satu daripada criteria tadi terus je start treatment!
Tapi... nak kasi ape eh?
Tapi... nak kasi ape eh?
Dear abang2 kakak2
Please bagi IV N-Acetylcysteine (NAC) STAT!
NAC ni 100% effective for first 8 hours of ingestion of PCM taw.
But boleh kasi upto 24h post ingestion
follow urutan:
1) 150mg/kg in 200mls D5% in 1H
2) 50mg/kg in 500mls D5% in 4H
3) 100mg/kg in 1 L D5% in 16h
Please bagi IV N-Acetylcysteine (NAC) STAT!
NAC ni 100% effective for first 8 hours of ingestion of PCM taw.
But boleh kasi upto 24h post ingestion
follow urutan:
1) 150mg/kg in 200mls D5% in 1H
2) 50mg/kg in 500mls D5% in 4H
3) 100mg/kg in 1 L D5% in 16h
so ape role NAC ni sebenarnya. bayangkan dia macam polis backup
dia ialah precursor to glutathione.
Dia repletes glutathione n tangkap semua remaining NAPQI tu and detoxify it away!
Yeay....
dia ialah precursor to glutathione.
Dia repletes glutathione n tangkap semua remaining NAPQI tu and detoxify it away!
Yeay....
so pt kita skarang ambik 20 tabs of PCM 5H ago right.
basically dah fit criteria utk initiate treatment.
kalau pt dtg within 1hour, then can do gastric lavage OR kasi activated charcoal. kalau dtg after 1H xyah kasi.
basically dah fit criteria utk initiate treatment.
kalau pt dtg within 1hour, then can do gastric lavage OR kasi activated charcoal. kalau dtg after 1H xyah kasi.
makesure you gais send blood especially Liver function test & Renal profile. Serum PCM level pun kena jgk especially sebb nk plot ada Rumack Matthew nnti kan
aku rasa tajuk ni penting sebb pcm ni awal2 semua org igt mcm harmless sebb most pt kalau present awal semu nmpak generally well.
Tapi tak, dia ialah bomb jangka.. death can occur after 72h n its our role to stop this.
Tapi tak, dia ialah bomb jangka.. death can occur after 72h n its our role to stop this.
nama penjenayah ni
NAPQI : N-acetyl-para-benzoquinoneimine
tergeliat lidah
NAPQI : N-acetyl-para-benzoquinoneimine
tergeliat lidah
