Understanding paracetamol-induced liver failure
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Paracetamol (N-acetyl-p-aminophenol) is among the most widely used over-the-counter antipyretic and analgesic drugs. Paracetamol is generally considered to be safe at recommended therapeutic doses but concerns accumulate worldwide, as it has been recognized as a frequent cause of acute liver failure (ALF).
Paracetamol is absorbed from the small intestine with a peak serum concentration within 1–2 h for tablet preparations and within 30 min for liquid preparations. Measured levels do normally not exceed 130 μmol/L but are dependent upon effective gastric emptying. The mechanism of action is not completely understood but is assumed to be related to inhibition of cyclooxygenase and modulation of the endogenous cannabinoid system. Following absorption paracetamol is mainly metabolized in the liver into water-soluble substances by glucuronidation and sulphation that are then excreted in the urine. A smaller fraction (10–15 %) is eliminated by N-hydroxylation by cytochrome...
KeywordsParacetamol Hepatic Encephalopathy Lactic Acidosis Acute Liver Failure Bioactivation
Acute liver failure
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