CPD reflective account ISTOCK
N-acetylcysteine treatment acts as an antidote, encouraging normal conjugation of any remaining paracetamol. N-acetylcysteine treatment is almost 100% effective in preventing liver damage if given within eight hours of paracetamol ingestion. Treatment consists of three repeated doses with no break between infusions.
Timed treatment
Paracetamol overdose A CPD article enhanced Anita Skinner’s knowledge of how to identify and treat paracetamol poisoning Paracetamol is safe and effective at the therapeutic dose. It is beneficial as an analgesic and is an effective antipyretic. Paracetamol is cheap and easy to buy over the counter, which makes it a common choice in intentional overdose. Taken orally, paracetamol is absorbed from the stomach and small intestine, reaching a peak plasma concentration in about one hour. During metabolism, 80-90% of paracetamol is inactivated in the liver by conjugation, resulting in non-toxic glucuronide and sulphate conjugates, which are excreted by the kidneys. Following overdose, the conjugation pathways become saturated, causing liver damage. Paracetamol poisoning may result in death from acute liver failure. Serious toxicity may occur where patients have ingested more than 150mg/kg body weight. Mortality from severe liver failure is less than 5% with supportive care.
Simplified guidelines on the management of paracetamol overdose were introduced in 2012. These are based on time since ingestion (in hours) at presentation. Reading the CPD article has improved my understanding of these guidelines. Patients with paracetamol poisoning are asymptomatic for the first 24 hours or have non-specific abdominal symptoms, such as nausea and vomiting. At this stage, liver function tests are normal. Hepatic necrosis begins to develop after this period and may progress to acute liver failure.
This reflective account is based on NS701 Pettie J, Dow M (2013) Assessment and management of paracetamol poisoning in adults. Nursing Standard. 27, 45, 39-47.
Monitoring of plasma paracetamol levels should begin four hours post-ingestion. All patients who have a timed plasma paracetamol level plotted on or above a curve drawn between 100mg/L at four hours after ingestion, and 15mg/L at 15 hours, should be given N-acetylcysteine. If there is doubt about time of ingestion, N-acetylcysteine should be given immediately. The plasma paracetamol concentration is likely to be below the limit of detection after 24 hours post-overdose. If paracetamol is detected, a full course of antidotal therapy should be given. The article reinforced the importance of taking an accurate patient history, including determining the amount of paracetamol ingested, the timing of ingestion, suicidal intent and if any other substances, such as alcohol, were ingested with the paracetamol NS Anita Skinner is a deputy matron/manager at Lourdes Community Nursing Home in Westgate-on-Sea, Kent
Write your own reflective account You can gain a certificate of learning by reading a Nursing Standard CPD article and writing a reflective account. Turn to page 52 for this week’s article and on page 62 you can find out how to present and submit your reflective account.
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N-acetylcysteine treatment acts as an antidote, encouraging normal conjugation of any remaining paracetamol. N-acetylcysteine treatment is almost 100% effective in preventing liver damage if given within eight hours of paracetamol ingestion. Treatment consists of three repeated doses with no break between infusions.
Timed treatment
Paracetamol overdose A CPD article enhanced Anita Skinner’s knowledge of how to identify and treat paracetamol poisoning Paracetamol is safe and effective at the therapeutic dose. It is beneficial as an analgesic and is an effective antipyretic. Paracetamol is cheap and easy to buy over the counter, which makes it a common choice in intentional overdose. Taken orally, paracetamol is absorbed from the stomach and small intestine, reaching a peak plasma concentration in about one hour. During metabolism, 80-90% of paracetamol is inactivated in the liver by conjugation, resulting in non-toxic glucuronide and sulphate conjugates, which are excreted by the kidneys. Following overdose, the conjugation pathways become saturated, causing liver damage. Paracetamol poisoning may result in death from acute liver failure. Serious toxicity may occur where patients have ingested more than 150mg/kg body weight. Mortality from severe liver failure is less than 5% with supportive care.
Simplified guidelines on the management of paracetamol overdose were introduced in 2012. These are based on time since ingestion (in hours) at presentation. Reading the CPD article has improved my understanding of these guidelines. Patients with paracetamol poisoning are asymptomatic for the first 24 hours or have non-specific abdominal symptoms, such as nausea and vomiting. At this stage, liver function tests are normal. Hepatic necrosis begins to develop after this period and may progress to acute liver failure.
This reflective account is based on NS701 Pettie J, Dow M (2013) Assessment and management of paracetamol poisoning in adults. Nursing Standard. 27, 45, 39-47.
Monitoring of plasma paracetamol levels should begin four hours post-ingestion. All patients who have a timed plasma paracetamol level plotted on or above a curve drawn between 100mg/L at four hours after ingestion, and 15mg/L at 15 hours, should be given N-acetylcysteine. If there is doubt about time of ingestion, N-acetylcysteine should be given immediately. The plasma paracetamol concentration is likely to be below the limit of detection after 24 hours post-overdose. If paracetamol is detected, a full course of antidotal therapy should be given. The article reinforced the importance of taking an accurate patient history, including determining the amount of paracetamol ingested, the timing of ingestion, suicidal intent and if any other substances, such as alcohol, were ingested with the paracetamol NS Anita Skinner is a deputy matron/manager at Lourdes Community Nursing Home in Westgate-on-Sea, Kent
Write your own reflective account You can gain a certificate of learning by reading a Nursing Standard CPD article and writing a reflective account. Turn to page 52 for this week’s article and on page 62 you can find out how to present and submit your reflective account.
Visit the RCN Learning Zone The RCN Learning Zone is a FREE online service to help RCN members with their continuing professional development and professional portfolio management. The RCN Learning Zone can be found at www.rcn.org.uk/members/learningzone.php
NURSING 18 other :: vol uses 29 no 25 :: permission. 2015 61 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Nov 25, 2015. For personalfebruary use only. No without Copyright © 2015 RCNi Ltd. All rights reserved.
