The clinical picture of an acute overdose develops in the first 24 hours after the administration of high doses of paracetamol. Symptoms of chronic overdose appear after 12-96 hours after increasing the dose of the drug.
Symptoms of acute overdose: diarrhea, decreased appetite, nausea, vomiting, discomfort and / or abdominal pain, pale skin. With the simultaneous introduction of paracetamol to adults at a dose of 7.5 g or more,and children more than 140 mg / kg cytolysis of hepatocytes occurs with complete and irreversible necrosis of liver development of hepatic insufficiency, metabolic acidosis and encephalopathy, which may lead to coma and death. Twelve hours after the administration of paracetamol, an increase in liver transaminases, lactate dehydrogenase and bilirubin levels, as well as a decrease in the level of prothrombin, was noted.
Symptoms of chronic overdose: developing hepatotoxic effect, characterized common symptoms (pain, fatigue, weakness, sweating), and specific symptoms characterizing liver damage may occur as a result gepatonekroz. Hepatotoxic effects of acetaminophen can be complicated by development of hepatic encephalopathy (thought disorder, central nervous system depression, anxiety or stupor), the occurrence of seizures, respiratory depression, coma, cerebral edema, hypoglycemia, metabolic acidosis, arrhythmias, collapse. Rarely, liver function abnormalities develop with lightning speed and can be complicated by renal failure (tubular necrosis).
Treatment: introduction of donators SH-band and the precursors of the synthesis of glutathione - methionine 8-9 hours after an overdose and N-acetylcysteine after 10 hours. The need for additional therapeutic measures (further introduction of methionine, intravenous administration N- acetylcysteine) is determined by the concentration of paracetamol in the blood plasma, as well as by the time elapsed after its administration.