Hapacol/Hapacol Junior Overdosage

Hapacol: Liver damage is possible in adults who have taken 10g or more of paracetamol.
Ingestion of 5g or more of paracetamol may lead to liver damage if the patient has risk factors (see as follows).
Risk Factors: If the patient: Is on long term treatment with carbamazepine, phenobarbitone, phenytoin, primidone, rifampicin, St John's Wort or other drugs that induce liver enzymes.
Or regularly consumes ethanol in excess of recommended amounts.
Or is likely to be glutathione deplete e.g. eating disorders, cystic fibrosis, HIV infection, starvation, cachexia.
Symptoms: Symptoms of paracetamol overdosage in the first 24 hours are pallor, nausea, vomiting, anorexia and abdominal pain. Liver damage may become apparent 12 to 48 hours after ingestion. Abnormalities of glucose metabolism and metabolic acidosis may occur. In severe poisoning, hepatic failure may progress to encephalopathy, haemorrhage, hypoglycaemia, cerebral oedema, and death. Acute renal failure with acute tubular necrosis, strongly suggested by loin pain, haematuria and proteinuria, may develop even in the absence of severe liver damage. Cardiac arrhythmias and pancreatitis have been reported.
Management: Immediate treatment is essential in the management of paracetamol overdose. Despite a lack of significant early symptoms, patients should be referred to hospital urgently for immediate medical attention. Symptoms may be limited to nausea or vomiting and may not reflect the severity of overdose or the risk of organ damage. Management should be in accordance with established treatment guidelines, see as follows.
Treatment with activated charcoal should be considered if the overdose has been taken within 1 hour. Plasma paracetamol concentration should be measured at 4 hours or later after ingestion (earlier concentrations are unreliable). Treatment with N-acetylcysteine may be used up to 24 hours after ingestion of paracetamol, however, the maximum protective effect is obtained up to 8 hours post-ingestion. The effectiveness of the antidote declines sharply after this time. If required the patient should be given intravenous N-acetylcysteine, in line with the established dosage schedule. If vomiting is not a problem, oral methionine may be a suitable alternative for remote areas, outside hospital. Management of patients who present with serious hepatic dysfunction beyond 24h from ingestion should be discussed with the NPIS or a liver unit.
Hapacol Junior: Poisoning is to be feared in the elderly and especially in young children (therapeutic overdose or frequent accidental intoxication) in which it can be fatal.
Symptoms: Nausea, vomiting, anorexia, pallor, abdominal pain usually appear within the first 24 hours.
Overdosage with 10 g of paracetamol as a single dose in adults and 150 mg/kg of body weight as a single dose in children results in hepatic cytolysis resulting in complete and irreversible necrosis and also causes hepatocellular insufficiency, metabolic acidosis, encephalopathy which can lead to coma and death.
At the same time, there is an increase in hepatic transaminases, lactic dehydrogenase, bilirubin and decreased prothrombin levels that may occur 12 to 48 hours after ingestion.
Emergency: Immediately transfer to hospitals.
Take a tube of blood to make the initial plasma dose of paracetamol.
Rapid evacuation of the product ingested by gastric lavage.
Treatment of overdosage typically involves administration as early as possible of the N-acetylcysteine antidote IV or orally if possible before the tenth hour.