NSAID Poisoning: Paracetamol

Paracetamol is a Non-Steroidal Anti Inflammatory Drug (NSAID). It is known as weak anti-inflammatory drug. It has weak analgesic potency. As it is potent anti-pyretic agent, it is used incase of fever, to reduce body temperature. It also has anti-platelet action.

It is taken orally as it is well absorbed from gastrointestinal tract because of the acidic environment inside the stomach. Its being acidic causes it to be less ionized in acidic media, results the prolonged stay in the gastrointestinal tract and increases absorption time thereby.

It is metabolized by the liver and excreted by the kidney.

• Panadol
• Tylenol
• Anacin-3
• Tempra
• Datril
• Napa

Two type of oral drug is available. This are:

• Solid
• Liquid

Oral tablets are of 250mg & 500mg

Suppository available: 125mg & 250mg

In case of pediatrics: 15mg/kilogram of body weight is given.

Signs & symptoms appear in 48 to 72 hours. Hepatotoxicity develops after 18 to 24 hours. The conventional signs & symptoms are:

• Nausea, vomiting
• Sweating
• Fall of body temperature (Hypothermia)
• Skin rash
• Right sub-costal pain
• Tender hepatomegaly
• on microscopic examination of liver necrosis of hepatocyte is seen

• Any sort of drug overdose is considered as poisoning. Immediate hospitalization for any poisoning case. Because, it is regarded as Police case.
• We know that Gastric emptying time is two to four hours. So, with in four hours, activated charcoal is given orally to prevent absorption of drug.
• Intravenous diuretics is given; which will help the kidneys to excrete the drug previously absorbed.
• Antidote is given. In case of Paracetamol, the antidote is Acetylcystine.
• Intravenous steroid and antihistamine should be given to reduce pseudo allergic rashes produced by Acetylcystine.
• Fluid and electrolyte balance should be maintained and closely monitored.
• Maintenance of blood glucose level is a must.

• Prothrombine Time: An increase in prothrombine time indicates liver failure. Normally it is 12 to 16 seconds.
• Serum Creatinine: An increase in serum creatinine level indicates renal failure. Normally the range is 0.6 to 1.4 in case of male and 0.6 to 1.6 in case of female.
• Acidity of Blood: Paracetamol is an acidic drug. Therefore, it causes metabolic acidosis.

An increase in above mentioned measures after Acetylcystine indicates poor prognosis. So the following this should be monitored:

• Intravenous fluid, electrolyte supply.
• Catheterization of patient to avoid urinary retention.
• Clear idea about blood glucose level and nutritional status of the patient.

Patient of any poisoning case is to be cared of properly, or else it may cost life.