1.2.1 Acetaminophen/Paracetamol 

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Small acetaminophen are efficiently processed in the liver to glucuronide or sulphate derivatives and removed via the urine. Paracetamol is processed via the microsomal cytochrome P-450 system, whereby potentially toxic derivatives are formed. By binding with glutathione, these can be detoxified. If this does not happen, an irreversible binding with liver cell proteins occurs. This leads to cell necrosis.

The causes of paracetamol intoxication are:

1) 50% accidental;

2) 50% suicide.

Characteristics of patients with paracetamol intoxication:

1) 50% with alcohol or drug problems;

2) 60% take antidepressants.

Laboratory tests show a very strong increase in transaminases (> 1000), an increase in creatinine and the development of metabolic acidosis. The toxicology screen on urine can show paracetamol.

Treatment consists of nasogastric lavage (if paracetamol was taken less than 4 hours before) and administration of activated charcoal (1 g/kg). Intravenous acetylcysteine ​​(glutathione donor) should be administered if liver function tests are impaired.

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