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Paracetamol poisoning (Pathophysiology (Toxic at >150mg/kg or 12g…

- - - - Activated charcoal
        Indication: ingestion <1h
        MOA: reduces absorption
      - N-acetylcysteine
        Indication: above tx line on graph;
        ASAP if staggered dose (>1h)/unclear timing
        MOA: antidote by as a glutathione precursor;
        most effective <8h, effective up until 72h
        SEs: pruritus, rash, nausea, angioedema, urticaria, bronchospasm (antihistamine, only stop if anaphylaxis)
      - Methionine
        Indication: N-acet unavailable
        MOA: antidote (less effective)
        SEs: nil
      - H2 antagonists
        Indication: ulcer prophylaxis
        MOA: aid recovery of ischemic injury to mucosa
        and mechanical damage from NG tubes
        E.g. ranitidine
      - Antibiotics/antifungals
        Indication: prophylaxis
        E.g. tazocin, fluconazole
    - - Liver transplant
        Indication: high lactate after fluid resus, low pH after fluid resus, deranged INR after resus, high Cr, grade 3/4 encephalopathy, high phosphate, signs of CNS oedema (high BP, bradycardia, decerebrate, extensor spasms, reduced papillary reflexes)