Symptoms: symptoms of paracetamol overdose during the first 24 bolt: pallor of the skin, nausea, vomiting, anorexia and abdominal pain. Damage to the liver can occur 12-48 hours after admission, so you need to see a doctor even if you have no symptoms. Possible disturbance of glucose metabolism and metabolic acidosis. In severe poisoning, liver failure may progress with complications such as encephalopathy, hemorrhage, hypoglycemia, cerebral edema and death. Acute renal failure with acute tubular necrosis (defined by pain in the lower back, hematuria and proteinuria) can develop even in the absence of severe liver damage. There are reports of heart rhythm disturbances and pancreatitis.
An overdose of phenylephrine hydrochloride can also cause nausea and vomiting. In addition, the symptoms include nervousness, headache, dizziness, insomnia, hypertension, reflex bradycardia, mydriasis, acute closed-angle glaucoma (most likely in patients with closed-angle glaucoma), tachycardia, palpitations, allergic reactions (eg, rash,urticaria, allergic dermatitis), dysuria and urinary retention (most likely in patients with obstruction of the bladder outlet, for example prostatic hypertrophy). Features of severe overdose of phenylephrine hydrochloride include hemodynamic changes and cardiovascular insufficiency with respiratory depression, hallucinations, seizures and arrhythmias. However, in the case of this combined preparation containing paracetamol, phenylephrine hydrochloride and ascorbic acid, an overdose will rather cause symptoms of liver toxicity associated with paracetamol than toxicity symptoms associated with phenylephrine or ascorbic acid.
High doses of ascorbic acid (more than 3000 mg) can cause temporary osmotic diarrhea and impairment of the gastrointestinal tract, such as nausea, discomfort in the stomach.
Treatment: symptomatic. You need immediate treatment with an overdose of paracetamol. Despite the lack of significant early symptoms, patients should be rushed to the hospital for immediate medical examination.Symptoms may be limited to the top note or vomiting and do not correspond to the severity of the overdose or the risk of organ damage. Damage to the liver can occur 12-48 hours after paracetamol enters the interior, so it is necessary to consult a doctor even if there are no symptoms.
Treatment with activated charcoal and gastric lavage should be considered if an excessive dose has been taken less than 1 hour ago. The concentration of paracetamol in plasma should be measured after 4 hours or more after administration (earlier concentrations are unreliable).
Treatment N-acetylcysteine can be carried out up to 24 hours after taking paracetamol, however the maximum protective effect is achieved about 8 hours after taking the drug. The effectiveness of the antidote gradually decreases after this time. If necessary, enter intravenously N-acetylcysteine according to the established scheme of use. Outside the hospital, if there is no vomiting, you can apply methionine inside. Patients who have been treated with serious hepatic dysfunction 24 hours after taking the drug, should be referred to a specialist for poisoning.
In hypertensive effects of phenylephrine hydrochloride overdose, intravenous alpha-receptor blockers, such as phentolamine, can be used.
Additional information about specific patient groups
The increased risk of liver damage with paracetamol overdose is most likely in:
- Patients receiving long-term treatment with enzyme-inducing agents (such as, carbamazepine, phenobarbitone, phenytoin, primidon, rifampicin and St. John's wort pitted);
- patients who consume alcohol in quantities higher than those recommended;
- patients with glutathione depletion (eg, patients with eating disorders, cystic fibrosis, HIV infection, cachexia, starvation).