DrVirgo
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22.
An 18-year-old man attempts suicide by taking 15 g of acetaminophen. Four hours after the overdose, high levels of acetaminophen are found in the plasma. The most appropriate therapy is
A
)
hemodialysis
B
)
oral administration of aspirin
C
)
oral administration of N-acetylcysteine
D
)
respiratory support and watchful waiting
E
)
urinary alkalinization and forced diuresis
Everyone agree with C? Or is there something else we do first?
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| robin082006
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C
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| drpkaur
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C-agree
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| mjl1717
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Yes.. My q is what other use does n-acetylcysteine have?
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| robin082006
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Productive cough, Cystic fibrosis
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| mjl1717
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Wow that was excellent and fast!
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| dariush
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ok C but what if the blood level is to high?
shouldn`t we also consider urinary alkalinization and forced diuresis ? after this long?
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| dariush
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ok C but what if the blood level is to high?
shouldn`t we also consider urinary alkalinization and forced diuresis ? after this long?
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| Slacker
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C.i think its a good idea to replnish glutathion levels so free radicals can be neutralized in the blood. urinary alkalinization and and forced diuresis can be used for ASA toxicity, i think. plz correct me...not sure.
Edited by Slacker on 05/11/06 - 02:29 PM
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| DrVirgo
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Thanks for confirming. 
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| nadiabarati
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Paracetamol overdose
Intravenous acetylcysteine is indicated for the treatment of paracetamol (acetaminophen) overdose. Oral acetylcysteine for this indication is uncommon as it is poorly tolerated owing to the high doses required (due to poor oral bioavailability), unpleasant taste/odour and adverse drug reactions (particularly nausea and vomiting).
For this indication, acetylcysteine acts to augment glutathione reserves (depleted by toxic paracetamol metabolites) in the body and, together with glutathione to directly bind to toxic metabolites. These actions serve to protect hepatocytes in the liver from toxicity due to paracetamol overdose.
[edit]
I think the answer is hemodialysis.
oral acetylcysteine is of no use here.
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| asherif
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nadiabarati wrote:
Paracetamol overdose
Intravenous acetylcysteine is indicated for the treatment of paracetamol (acetaminophen) overdose. Oral acetylcysteine for this indication is uncommon as it is poorly tolerated owing to the high doses required (due to poor oral bioavailability), unpleasant taste/odour and adverse drug reactions (particularly nausea and vomiting).
For this indication, acetylcysteine acts to augment glutathione reserves (depleted by toxic paracetamol metabolites) in the body and, together with glutathione to directly bind to toxic metabolites. These actions serve to protect hepatocytes in the liver from toxicity due to paracetamol overdose.
[edit]
I think the answer is hemodialysis.
oral acetylcysteine is of no use here.
I Agree. a)Hemodialysis
Methionine is used as Oral antidote used for Acetaminophen overdosage and not N-Acetyl cysteine which is used Intravenous.
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| vallia
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I go with C
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| DrVirgo
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I still think its C!
NAC has been used in clinical toxicology for the treatment of acetaminophen poisoning. Glutathione detoxifies acetaminophen, but once glutathione is depleted there can be significant cell death in the liver [THE AMERICAN JOURNAL OF MEDICINE; Flanagan,RJ; 91(Suppl C):131S-139S (1991)].
Oral supplementation with N-AcetylCysteine (NAC) provides an alternate means of boosting intracellular glutathione via elevated intracellular cysteine. NAC is rapidly absorbed after oral administration and reaches a maximum plasma level in 2-3 hours, with a half-life of about 6 hours. NAC readily enters cells and is hydrolyzed to cysteine.
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| nadiabarati
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opposite article on the same subject?? these drive me bonkers....
So IV or Oral both are used right?
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| robin082006
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Oral is used in practice.
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| DrVirgo
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agree. Just remember NAC for Acet. OD... It replenishes GSH... All other choices would be distractors.
By the way when would we use hemodialysis for drug OD? (just for discussion)
And when would we alkalanize the urine or acidify it (in which drug OD's)?
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| DrVirgo
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In FA it mentions that NAC is antidote- regenerates GSH and or binds "NAPQI"
What is NAPQI?
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| mjl1717
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you can alkalinize the urine in barbiturate overdose to expediate excretion
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| nadiabarati
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Drvirgo, NAPQI is the toxic metabolite of acetaminophen which is produced by CYTP450
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| DrVirgo
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Yes, but what does it stand for? I just know it as Free Radicals.
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| docarchana
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I think C is the ans..
NAPQ1 IS N acetyl benzo quinoneimine
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