PARACETAMOL AND
PARACETAMOL OVERDOSE
LECTURER ; DR MOHAMMED
GROUP MEMBERS
1. Moradeyo Oluseyi Abigael - 2022/38632
2. Babajide Adebola Grace - 2023/49941
3. Saheed Zainab Bolanle - 2022/38127
4. Otabor Christabel Victoria - 2022/38275
5. Kayode Favour Deborah - 2022/38096
COURSE OUTLINE
1. Introduction and Overview
2. Paracetamol Overdose
3. Consequences of Paracetamol Overdose
4. Management and Treatment
5. Prevention Strategies
6. Conclusion
INTRODUCTION
Paracetamol, also known as acetaminophen, is a widely used over-the-
counter medication for pain relief and fever reduction. However, its overdose
can lead to severe consequences, including liver damage and failure. In this
presentation, we will discuss the importance of responsible paracetamol use,
the risks associated with its overdose, and the strategies for prevention and
management.
Paracetamol Overview
Uses of Paracetamol
Paracetamol is a popular medication used
1. To relieve mild to moderate pain,
2. Osteoarthritis
3. To reduce fever both in children and adukts
4. Alleviate symptoms associated with headaches,toothaches, and menstrual cramps.
Benefits of Paracetamol
a) Effective pain relief
b) Antipyretic properties
c) Widely available and affordable
d) It is considered safe for therapeutic uses
e) Non- Sedative like opioids.
Dosage Administration
The recommended dosage of paracetamol varies depending on age, weight, and medical
condition.
1. Adult dosage: 500-1000 mg every 4-6 hours, not exceeding 4000 mg in 24 hours
2. Pediatric dosage: varies depending on age and weight. 10–15 mg per kg of body weight per
dose
Example:
For a child weighing 20 kg:
Dose = 10–15 mg/kg = 200–300 mg per dose
Can be given every 4–6 hours, but not more than 4 doses/day
Mechanism of Action
1. Central Inhibition of Prostaglandin Synthesis:
Prostaglandins are chemicals that promote inflammation, pain, and fever. Paracetamol
inhibits cyclooxygenase (COX) enzymes, especially COX-2, in the brain, reducing the
production of prostaglandins in the central nervous system.
2. Activation of Descending Serotonergic Pathways:
Paracetamol may increase the activity of descending inhibitory serotonin pathways, which
dampen the perception of pain in the spinal cord.
Paracetamol Overdose
Definition of Paracetamol Overdose;
A Paracetamol (Acetaminophen) overdose occurs when a person takes more than the recommended maximum daily dose,
leading to toxic levels in the body. This can result in liver damage and, if untreated, liver failure or death.
Maximum safe dose for children is 60 mg/kg/day (up to 75 mg/kg/day) and for adult is 4000mg (4 grams/day)
Toxic Dose in Adult is 7.5-10 grams/day and for children is 150mg/kg/day
Causes of Paracetamol overdose
1. Accidental Overdose
2. Intentional Overdose
3. Chronic Overdose
4. Inaccurate dosing in children
Risk Factor for Paracetamol Overdose
1. Age-Related Risks
2. Liver Dysfunction
3. Nutritional Deficiency
4. Enzyme-Inducing Drugs
5. Chronic Paracetamol Use
6. Intentional Overdose or Self-Harm
7. Incorrect Dosing
8. Dehydration or Acute Illness
Consequences of Paracetamol Overdose;
1. Liver Damage (Hepatotoxicity);
Symptoms: Nausea, vomiting, right upper abdominal pain, fatigue, jaundice and confusion
Mechanism: The liver converts paracetamol into a toxic metabolite (NAPQI), which in high amounts
overwhelms the body's natural detoxifying substance (glutathione), leading to liver cell death.
2. Acute Liver Failure;
Symptoms: Coagulation problems, hypoglycemia, and multi-organ failure.
3. Kidney Damage
4. Metabolic Acidosis
5. Death
Management and Treatment of
Paracetamol Overdose
1. Initial Assessment and Stabilization:
A. Assess the airway, breathing, and circulation (ABCs): Ensure the patient's vital signs are stable.
B. Gather information: Determine the amount and time of paracetamol ingestion.
C. Perform physical examination: Look for signs of toxicity, such as nausea, vomiting, or abdominal pain.
2. Activated Charcoal Administration:
A. Indications: Administer activated charcoal if the patient presents within 1-2 hours of ingestion.
B. Dosage: The typical dose is 50-100 grams for adults.
C. Purpose: Activated charcoal helps absorb paracetamol in the gut, reducing absorption into the bloodstream.
3. N-acetylcysteine (NAC) Treatment:
A. Indications: NAC is administered to treat paracetamol overdose and prevent liver damage.
B. Dosage: The typical regimen involves an initial IV dose followed by subsequent doses.
C. Purpose: NAC replenishes glutathione stores in the liver, helping to detoxify the toxic metabolite of paracetamol.
4. Monitoring and Follow-up:
A. Liver function tests (LFTs): Monitor LFTs, such as ALT and AST, to assess liver damage.
B. Paracetamol levels: Measure paracetamol levels to guide treatment decisions.
C. Clinical monitoring: Closely monitor the patient's clinical condition, including signs of liver damage or other complications.
D. Follow-up: Schedule follow-up appointments to ensure the patient's liver function has returned to normal.
Strategies to adopt in prevention of paracetamol overdose
1.Patient Education;
• Teach safe dosage limits: Emphasize the maximum daily dose (usually 4g for adults).
• Highlight hidden sources: Educate patients that many OTC and prescription drugs contain paracetamol.
• Explain dosing for children
2. Medication Review and Monitoring
• Review all medications: Check for duplicate therapy or multiple products containing paracetamol
•Monitor for symptoms of overdose: Be alert for early signs like nausea, vomiting, or pain
• Assess liver function: Especially in patients with liver disease, alcohol use, or malnutrition.
3. Safe Administration Practices
• Double-check doses
• Use electronic systems: Utilize electronic health records (EHR) to flag high-risk doses or duplicate medications.
4. Communication and Documentation
• Report and document adverse effects
• Communicate with the other healthcare team
5. Health Promotion and Advocacy
• Promote public awareness
• Advocate for safer practices
6. Emergency Preparedness
• Be familiar with hospital protocols for managing suspected overdose (e.g., use of activated charcoal
or N-acetylcysteine).
• Recognize and respond rapidly to signs of toxicity.
IN CONCLUSION
Paracetamol (also known as acetaminophen) is a non-opioid drug. It is classified as an
analgesic (pain reliever) and antipyretic (fever reducer), commonly used to treat mild to
moderate pain and fever.
Unlike opioids, it does not act on opioid receptors in the brain and does not cause euphoria or
dependence. It works mainly by inhibiting an enzyme in the brain involved in pain and
temperature regulation.
Paracetamol (acetaminophen) is not classified as an NSAID because it lacks significant anti-
inflammatory activity, which is a defining feature of NSAIDs. It also has no significant effect on
platelets which is responsible for blood clotting. A major consequences of using it's overdose
are Liver damage. It is our responsibility as a nurse to sensitize the community on the dangers
attached to taking it's overdose so we all can have a healthy life.
