Overdose - PCM/APAP Poisoning

[0utrider]

This thread is supposed to be about infos & experiences with PCM poisoning. To avoid this, one should always consider a Cold-Water-Extraction: CWE FAQ: Links, Lists & Manuals !

I can, again, just stress the need to go to the hospital, if one feels sick! Don't play with your help, these steps here described are rather used for prevention than treatment. Self-treatment is not an option if you feel seriously sick or if you OD'd!!!!
I guess its always a good decision to have a healthy nutrition and take longer breaks between usage. Also drinking water is always adviced. Further information needed.

I'll start with a short summary:

Acetylcysteine as an Antidote

(if overdosed toxic itself, drinking lots of water always recommended due to possible harm to kidneys)

"Administration of activated charcoal should be considered if paracetamol in excess of 150 mg/kg or 12 g whichever is the smaller, is thought to have been ingested within the previous hour.

Acetylcysteine protects the liver if infused within 24 hours of ingesting paracetamol. It is most effective if given within 8 hours of ingestion after which effectiveness declines sharply; if more than 24 hours have elapsed advice should be sought from a poisons information centre or from a liver unit on the management of serious liver damage. In remote areas methionine (2.5 g) by mouth is an alternative if acetylcysteine cannot be given promptly. Once the patient reaches hospital the need to continue treatment with the antidote will be assessed from the plasma-paracetamol concentration (related to the time from ingestion).

Patients at risk of liver damage and therefore requiring treatment can be identified from a single measurement of the plasma-paracetamol concentration, related to the time from ingestion, provided this time interval is not less than 4 hours; earlier samples may be misleading. The concentration is plotted on a paracetamol treatment graph of a reference line (‘normal treatment line') joining plots of 200 mg/litre (1.32 mmol/litre) at 4 hours and 6.25 mg/litre (0.04 mmol/litre) at 24 hours. Those whose plasma-paracetamol concentration is above the normal treatment line are treated with acetylcysteine by intravenous infusion (or, if acetylcysteine is not available, with methionine by mouth, provided the overdose has been taken within 10–12 hours and the patient is not vomiting).

Patients on enzyme-inducing drugs (e.g. carbamazepine, phenobarbital, phenytoin, primidone, rifampicin, alcohol, and St John’s wort) or who are malnourished (e.g. in anorexia, in alcoholism, or those who are HIV-positive) may develop toxicity at lower plasma-paracetamol concentration and should be treated if the concentration is above the high-risk treatment line (which joins plots that are at 50% of the plasma-paracetamol concentrations of the normal treatment line).

The prognostic accuracy of plasma-paracetamol concentration taken after 15 hours is uncertain but a concentration above the relevant treatment line should be regarded as carrying a serious risk of liver damage.
Plasma-paracetamol concentration may be difficult to interpret when paracetamol has been ingested over several hours. If there is doubt about timing or the need for treatment then the patient should be treated with an antidote." thanks to Jatelka.

maybe this link will also provide some infos
http://en.wikipedia.org/wiki/Acetylcysteine
Grapefruit juice and APAP. GPJ is an inhibitor of CYP3A4, which is a minor
metabolizer of hydrocodone and a major
metabolizer of acetaminophen. What this means is that degree to
which plasma concentrations of acetaminophen increase would be much
greater than the degree to which plasma levels of hydrocodone would
increase; thus the risk of liver toxicity is actually higher.

[RoboCodeine7610]

Thanx for all this information, SWIY has been extremely helpful in this forum.
Keep up the good work!