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Due to overdosage of Acetaminophen in elderly persons, small children, patients with liver disorder, chronic alcohol consumption or chronic malnutrition, as well as patients co-administered with enzyme-inducing drugs are at an increased risk intoxication, including fatal outcomes.
Symptoms: Hyoscine Butylbromide: In the case of overdose, anticholinergic effects have been observed.
Acetaminophen: Symptoms normally occur during the first 24 hours and include pallor, nausea, vomiting, anorexia and abdominal pain. Patients may then experience a temporary subjective improvement but mild abdominal pain possibly indicative of liver damage may persist.
A single dose of Acetaminophen approximately 6 g or more in adults or 140 mg/kg in children may cause hepatocellular necrosis. This may lead to complete irreversible necrosis and subsequently to hepatocellular insufficiency, metabolic acidosis and encephalopathy, which may turn progress to coma and death. Concurrent rises in liver transaminases (AST, ALT), lactate dehydrogenase and bilirubin and an increase in prothrombin time, occurring 12-48 hours after ingestion have been observed. Clinical symptoms of liver damage are normally apparent after 2 days and reach a maximum after 4-6 days.
Acute renal failure with acute tubular necrosis may develop even in the absence of severe damage. Other non-hepatic symptoms such as myocardial abnormalities and pancreatitis have also been reported to occur after Acetaminophen overdosage.
Therapy: Hyoscine Butylbromide: If required, parasympathomimetic drugs should be administered. Ophtalmological advice should be sought urgently in cases of glaucoma.
Cardiovascular complications should be treated according to usual therapeutic principles.
In case of respiratory paralysis: intubation, artificial respiration should be considered. Catheterization may be required for urinary retention. In addition, appropriate supportive measures should be used as required.
Acetaminophen: Where Acetaminophen intoxication is suspected, intravenous administration of SH group donators such as N-Acetylcysteine within the first 10 hours after ingestion is indicated. Although N-Acetylcysteine is most effective if initiated within this period, it can still offer some degree of protection if given as late as 48 hours after ingestion; in this case, it is taken for longer. The plasma concentration of Acetaminophen can be decreased by dialysis. Determinations of the plasma concentration of Acetaminophen are recommended.
Further measures will depend on the severity, nature and course of clinical symptoms of Acetaminophen intoxication and should follow standard.
