One of the most commonly used antipyretic and analgesic is paracetamol. Considered to be very safe with the least nephrotoxic potential, it is widely prescribed in all age groups. Like most lipid soluble drugs, paracetamol is metabolised in the liver. The major metabolites are sulphate and glucoronide conjugates of the drug which are highly water soluble and rapidly eliminated from the body. A minor metabolite is N acetyl p aminobenzoquinone Imine (NAPQI) formed by CYP2E1. With increase in dose, the major pathways are saturated, and the formation of the metabolite NAPQI increases. NAPQI has hepatotoxic potential. The endogenous scavengers ( read glutathione) detoxify the toxin but in overdosage of paracetamol, the scavengers are overwhelmed and hepatotoxicity occurs. The antidote recommended for treatment of paracetamol induced liver injury is N acetyl cysteine. N acetyl cysteine is an antioxidant and is a precursor of glutathione and therefore replenishes tissue glutathione stores. Replenished glutathione detoxify NAPQI and prevent hepatic injury.
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Well written. Paracetamol overdose is one of the important topic in MRCP question. It help a lot😊
ReplyDeleteWell written sir✌💉
ReplyDeleteWell written sir..
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