Paracetamol Poisoning

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Submitted By Mrdobson
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SECTION 1. POISONING IN THE EMERGENCY SETTING

Definition

A poison is any substance which, when taken into the body in sufficient quantity, may either endanger life or seriously impair body functions (IHCD 1999).

Introduction

Poisons come in many forms and can enter the body in many ways: Inhalation – fumes, gases; Ingestion – liquids or solids by mouth; Injection – needles, animal and insect bites; Absorption – pesticides or herbicides through the skin and eyes.
In the field of accident and emergency we see cases of poisoning that are both accidental and intentional. A massive 85% of these cases involve just three types of drug: Paracetamol 45% Benzodiazepines 20% Antidepressants 20% (Daly; Harrison, 2001).

As the majority of our cases come from these non-corrosive types of poisons the author will concentrate only on overdoses of drugs, with the second section solely devoted to the most common of these; Paracetamol.

Clinical Signs of Poisoning

The majority of drugs effect the nervous system and produce some common signs: ▪ Slow, shallow respiration’s ▪ Lethargy and reduction in activity ▪ Vomiting and diarrhoea ▪ Loss of consciousness
Some drugs though, such as Paracetamol are asymptomatic during the early stages of poisoning.

Although in the majority of cases our treatment in the field for poisoning will be the same irrespective of the drug involved, certain signs can point to the type of drug taken. Below are some examples of these.

➢ Eyes: Pinpoint – opioids. Dilated – tricylics, cocaine. ➢ CNS Drowsiness – alcohol, sedatives, opioids, hypnotics. ➢ Confusion/Ataxia/Excitability – alcohol, tricyclics, antihistimines, salbutamol, solvents. ➢ Dystonia – metaclopramide, phenothiazenes…...

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