ABSTRACT
This chapter presents a case study of a 21-year-old girl who is brought to the Emergency Department by her friend, having been found to have taken a paracetamol overdose. In the setting of drug overdose, paracetamol is the common medication of choice. Most patients presenting acutely are asymptomatic or complain of mild abdominal symptoms such as nausea and vomiting. In usual doses, active paracetamol is conjugated in the liver to its inactive form; a small percentage is metabolised by cytochrome P450 to produce the toxic metabolite N-acetyl-p-benzoquinone (NAPQI), which is inactivated by undergoing further conjugation with glutathione. Initial blood investigations should include liver function tests, INR, renal function tests and a venous blood gas analysis to check bicarbonate and metabolic acidosis. Patients should be monitored for side effects of N-acetylcysteine (NAC), which include erythema, urticaria, bronchospasm, angioedema and hypotension.
