Journal Mobile

DN Bateman
Journal Issue: 
Volume 37: Issue 4: 2007




Presentations  with  acute  self  harm  are  a  worldwide  problem. In developed countries drug overdose is a common form of self harm, and in the UK the most frequently involved agent is paracetamol, implicated in around one-third of presentations.  Risk factors for paracetamol hepatotoxicity include starvation, eating  disorders, and  enzyme  induction  from  drugs  and  alcohol.  Treatment  is based on assessment of these and time since ingestion.  Antidotal therapy is with acetylcysteine. Assessment of treatment efficacy is based on measurement of liver function  tests  and  serum  creatinine. Adverse  reactions  to  the  antidote acetylcysteine are frequent, thus understanding their mechanisms and treatment is important. Treatment of patients presenting after 20 hours is aimed at preventing hepatic  encephalopathy.  Patients  presenting  with  severe  liver  damage  should  be considered for referral to a specialised centre