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Why does an overdose of acetaminophen cause your liver to collapse? Look at these amazing processes!
Excessive use of acetaminophen is considered to be one of the important causes of liver poisoning. There are more than 100,000 cases of acetaminophen poisoning in the United States each year, especially among young children. As everyone knows, this drug, which is commonly used as an analgesic and antipyretic, may cause irreversible damage to the liver if used improperly.
Acetaminophen itself does not directly cause liver damage, but is caused by its metabolite N-acetyl-p-benzoquinoneimine (NAPQI).
Initial symptoms of poisoning
Initial symptoms of poisoning are usually not obvious within 24 hours after overdose, and include non-specific symptoms such as fatigue, abdominal pain and nausea. Many patients experience no obvious symptoms within the first few days, making it common for self-medication or misuse of medication to occur.
However, the condition can evolve over time. Within 24 to 72 hours, liver damage will become more apparent, and patients may experience upper right abdominal pain. At this time, biochemical indicators will show impaired liver function and significantly increased levels of transaminases (ALT and AST).
When AST and ALT exceed 1000 IU/L, hepatocyte necrosis caused by acetaminophen can be diagnosed.
The final stage of poisoning
After 3 to 5 days, if the condition continues to worsen, it may lead to crazy necrosis of the liver and systemic multi-organ failure, which may eventually lead to death. However, if this stage can be overcome, patients usually return to normal within a few weeks.
The severity of liver damage depends on the dose taken and prompt receipt of appropriate treatment.
Main causes of liver damage
At normal treatment doses, acetaminophen is relatively safe, but once it is taken in excess, it will seriously challenge the liver's detoxification ability. When the liver's ability to metabolize the drug exceeds its ability to process it, NAPQI production increases, causing direct damage to liver cells.
In animal studies, liver glutathione reserves must fall below 70% of normal levels before liver toxicity occurs.
Causative factors and risk factors
In addition to dose, certain factors may increase the risk of acetaminophen poisoning. Excessive alcohol consumption, malnutrition, and concomitant use of certain hepatotoxic drugs can all contribute to the development of this type of poisoning. Chronic alcohol users, in particular, may in some cases increase the toxicity of acetaminophen.
In addition, some drugs such as isoniazid and certain anti-epileptic drugs may further increase the risk of hepatotoxicity.
Diagnosis and Treatment
The best way to determine acetaminophen poisoning is to test its concentration in the blood. The Rumack–Matthew nomogram is an effective tool used by health care providers to assess the risk of acetaminophen poisoning in the hours after taking the drug.
Gastrointestinal detoxification can be carried out in the early stage of poisoning. It is usually recommended to do it within 2 hours after taking the medicine for the best effect. The most common detoxification measure is the administration of activated charcoal, which effectively adsorbs acetaminophen.
For later poisoning, N-acetylcysteine is the main antidote and can effectively reduce the risk of liver damage.
Preventive measures
One of the main directions for subsequent preventive measures is to limit the availability of acetaminophen. For example, some countries have limited the number of sales packages. Other strategies such as combined sales with anti-venom agents and the development of new drug alternatives are options being explored.
Although excessive use of acetaminophen poses a great threat to health, its safety in treatment cannot be ignored. Therefore, it is necessary to strengthen publicity in the medical and public health fields to improve patients' Self-monitoring awareness.
However, as our understanding of this process deepens, we can't help but think: Do we really pay attention to the safety and correctness of medication when taking medication on daily basis?
