Medical centers that might expect to receive large numbers of patients in a single incident should stock larger amounts of antidotes or have an effective and efficient drug sharing/transfer procedure in place to rapidly obtain additional antidotal supplies. If poisoning is severe, bilirubin and international normalized ratio may be elevated.For medical centers choosing to stock antidotes, the suggested stocking level is based on the dose needed to treat a single 100 kg patient for 8 hours and for 24 hours. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), 8.5% of US adults are estimated to. read more or alcoholic liver disease Alcohol-Related Liver Disease Alcohol consumption is high in most Western countries. Common causes include hepatitis B and C viruses, nonalcoholic steatohepatitis (NASH), alcohol-related liver disease, and autoimmune liver. AST levels > 1000 IU/L are more likely to result from acetaminophen poisoning than from chronic hepatitis Overview of Chronic Hepatitis Chronic hepatitis is hepatitis that lasts > 6 months. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) results correlate with the stage of poisoning (see table Stages of Acute Acetaminophen Poisoning ). Liver tests are done and, in suspected severe poisoning, prothrombin time is measured. If poisoning is confirmed or strongly suspected or if the time of ingestion is unclear or unknown, additional testing is indicated. For a single acute overdose with extended-relief acetaminophen (which has 2 peak serum levels about 4 hours apart), acetaminophen levels are measured ≥ 4 hours after ingestion and 4 hours later if either level is above the Rumack-Matthew line of toxicity, treatment is required. Higher levels indicate possible hepatotoxicity. A level ≤ 150 mcg/mL ( ≤ 990 micromol/L) and absence of toxic symptoms indicate that hepatotoxicity is very unlikely. For a single acute overdose of traditional acetaminophen or rapid-relief acetaminophen (which is absorbed 7 to 8 minutes faster), levels are measured ≥ 4 hours after ingestion and plotted on the nomogram. If the time of acute ingestion is known, the Rumack-Matthew nomogram is used to estimate likelihood of hepatotoxicity if the time of acute ingestion is unknown, the nomogram cannot be used. Likelihood and severity of hepatotoxicity caused by an acute ingestion can be predicted by the amount ingested or, more accurately, by the serum acetaminophen level. However, therapeutic doses of acetaminophen in alcoholic patients are not associated with hepatic injury. read more could increase risk of toxicity because hepatic enzyme preconditioning may increase formation of NAPQI and because undernutrition (also common among alcoholics) reduces hepatic glutathione stores. (Malnutrition also includes overnutrition.) Undernutrition can result from inadequate ingestion of nutrients, malabsorption, impaired metabolism, loss. read more or undernutrition Overview of Undernutrition Undernutrition is a form of malnutrition. Theoretically, alcoholic liver disease Alcohol-Related Liver Disease Alcohol consumption is high in most Western countries. As a result, NAPQI accumulates, causing hepatocellular necrosis and possibly damage to other organs (eg, kidneys, pancreas). An acute overdose depletes glutathione stores in the liver. The principal toxic metabolite of acetaminophen, N-acetyl- p-benzoquinone imine (NAPQI), is produced by the hepatic cytochrome P-450 enzyme system glutathione stores in the liver detoxify this metabolite.
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