- 150mg/kg or 12gm in adult may be fatal
- PCM overdose causes hepatic injury through its reactive metabolit (NAPQI), which is normally rapidly detoxified by glutathione in liver cells. In PCM overdose, NAPQI production exceeds glutathione capacity and the metabolite reacts directly with the hepatic macromolecules causing liver injury
- treatment includes oral activated charcoal within 3-4 hours of ingestion
- antidote: N-acetylcysteine or methionine if allergic to NAC
- criteria for transfer to liver unit
~ encephalopathy or raised ICP
~ INR >2.0 at <48hours or INR>3.5 at <72hours (so measure INR every 12hours)
~ renal impairment (creainine > 200 μmol/L)
~ blood pH < 7.3 (lactic acidosis)
~ systolic BP < 80mmHg
- liver markers are poor indicator of hepatocyte death
- King's college criteria for liver transplantation
~ arterial pH < 7.3 or lactate >3.0 after adequate fluid resuscitation
~ or if all three of the following occurs in first 24 hours
i) creatinine > 300
ii) PT > 100 or INR > 6.5
iii) grade III/IV encephalopathy
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