The drug should be taken only in recommended doses. When excess of the recommended dose immediately contact medical care, even if You feel good, because there is a risk of deferred serious damage to the liver.
Overdose is due, as typically, paracetamol.
Liver failure in adults possible when taking 10 or more grams of paracetamol. Receiving 5 and more gram of paracetamol can lead to liver damage in patients with the followingrisk factors:
- long-term treatment with carbamazepine, phenobarbital, phenytoin, primidonom, rifampicin, drugs Hypericum perforatum, or other drugs, stimulating liver enzymes;
- regular use of alcohol in excess quantities;
- deficiency of glutathione (due to malnutrition, cystic fibrosis, HIV infection, starvation, exhaustion).
Symptoms (due to paracetamol):
Within 24 hours are possible: pallor of the skin, anorexia, nausea, vomiting, abdominal pain. During 12-48 hours, signs of a liver function disorder may appear. There may be signs of impaired glucose metabolism and metabolic acidosis. In case of severe poisoning, severe hepatic insufficiency may develop hepatic encephalopathy, coma and death.
Sharp renal Insufficiency with acute necrosis of the tubules, which is diagnosed by severe pain in the lumbar region, hematuria and proteinuria, can develop without a serious impairment of liver function. There are reports of cardiac arrhythmias and pancreatitis in case of an overdose of paracetamol.
When first signs overdose should immediately call a doctor, even if there are no distinct symptoms of poisoning. In the early period, the symptomatology can be limited only by nausea and vomiting and may not reflect the severity of the overdose or the risk of injury to the internal organs.
Treatment: within the first hour after an alleged overdose it is advisable appointment activated carbon inside. Four or more hours after anticipated overdose is necessary determination of the concentration of paracetamol in the plasma (an earlier determination of the concentration of paracetamol may be unreliable). Treatment with acetylcysteine can be carried out up to 24 hours after taking paracetamol, but the maximum hepatoprotective effect can be obtained in the first 8 hours after an overdose. After that, the effectiveness of the antidote drops sharply. If necessary acetylcysteine can be administered intravenously. In the absence of vomiting an alternative option (in the absence of the possibility of rapid receipt of inpatient care) is the appointment of methionine inside. Treatment of patients with severe impairment of liver function 24 hours after taking paracetamol should be done in conjunction with specialists from the toxicology center or specialized department of liver diseases.
Symptoms (due to phenylephrine): irritability, headache, dizziness, insomnia, increased arterial pressure, nausea, vomiting, increased excitability, reflex bradycardia. AT severe cases of overdose possible the development of hallucinations, confusion, convulsions, arrhythmias.
An overdose of phenylephrine can cause symptoms similar to the side effect (see the "Side effect" section).
Treatment: symptomatic therapy, with severe arterial hypertension, the use of alpha-blockers, such as phentolamine.
Symptoms (due to ascorbic acid): at application of more than 1000 mg - headache, increased excitability of the central nervous system, insomnia, nausea, vomiting, diarrhea, hypercalic gastritis, gastrointestinal mucosal damage, suppression of the function of the insulin pancreas apparatus (hyperglycemia, glucosuria), hyperoxaluria, nephrolithiasis (from calcium oxalate), damage to glomerular renal apparatus, decreased capillary permeability (possibly worsening trophism of tissues, increased blood pressure, hypercoagulation, development of microangiopathies ).
High doses of ascorbic acid (more than 3000 mg) can cause temporary osmotic diarrhea and disruptions to the gastrointestinal tract, such as nausea, discomfort in the stomach.Manifestations of an overdose of ascorbic acid can be categorized as those that are caused by severe liver damage as a result of an overdose of paracetamol.
Treatment: symptomatic, forced diuresis.