2 English reference acetaminophen
Paracetamol [Landau Chinese-English Dictionary]
Acetaminophen [Xiangya Medical Dictionary]
3 national essential drugs and acetaminophen related national essential drugs retail guidance price information
Essential drug serial number
DirectoryNo. Drug name, dosage form and specification Retail unit refers to
Description of price category: 387 47 acetaminophen tablets 500mg* 10 box (bottle)10.7 chemical and biological products * 388 47 acetaminophen tablets 300mg*24 boxes (bottle) 2.7 chemical and biological products 389 47 acetaminophen tablets 500mg *10.
1, and those marked with "*" in the remarks column in the table are representative products.
2. If "△" is marked in the remarks column for the specifications representing dosage forms in the table, the prices representing dosage forms and related specifications with a clear price difference are tentative prices.
Overview acetaminophen is the active metabolite of phenacetin, which is a white crystal or crystalline powder; Odorless, slightly bitter. Its analgesic mechanism is not very clear, which may be due to inhibiting the synthesis of prostaglandin in the central nervous system and blocking the impulse of pain nerve endings. It has good antipyretic and analgesic effects, and has no effect on platelet and coagulation mechanism. The blood concentration of adult poisoning is 65438 0.5 mg/dl. The toxic dose of children was 1.50 mg/kg. It mainly damages the liver, kidneys and blood system, with occasional allergic reactions.
5 Pharmacopoeia standard of acetaminophen 5. 1 name 5. 1. 1 Chinese name acetaminophen
5. 1.2 Chinese Pinyin Pair Line' Anji Score'
5. 1.3 English name paracetamol
5.2 Structural Formula 5.3 Molecular Formula and Molecular Weight C8H9NO2? 15 1. 16
5.4 Source (name) and content (potency) This product is 4' hydroxyacetanilide. Calculated by dry product, the content of C8H9NO2 should be 98.0% ~ 102.0%.
5.5 Characteristics This product is white crystal or crystalline powder; Odorless, slightly bitter.
This product is soluble in hot water or ethanol, soluble in acetone and slightly soluble in water.
5.5. 1 melting point The melting point of this product (Appendix ⅵ C of Pharmacopoeia Part II, 20 10) is 168 ~ 172℃.
5.6 Identification (1) The aqueous solution of this product turns blue-purple when added with ferric chloride test solution.
(2) Take about 0.65438 0 g of this product, add 5ml of dilute hydrochloric acid, heat it in water bath for 40 minutes, and cool it; Take 0.5ml, add 5 drops of sodium nitrite test solution, shake well, dilute with 3ml of water, add 2ml of alkaline β naphthol test solution, shake well and turn red.
(3) The infrared absorption spectrum of this product should be consistent with that of the reference substance (figure 13 1).
5.7 Check the acidity of 5.7. 1 Take 0. 10g of this product, add 10ml of water to dissolve it, and measure it according to law (Appendix 6 h of Pharmacopoeia Part II, 20 10), and the pH value should be 5.5 ~ 6.5.
5.7.2 Take 65438±0.0g of this product for clarity and color of ethanol solution, add 65438±00ml of ethanol to dissolve, and the solution should be clear and colorless; If it is turbid, it should not be thicker than the turbidity standard solution. 1 (appendix ⅸ b of Pharmacopoeia II, 20 10); If the color is developed, it should be no deeper than the standard colorimetric solution of Brown Red No.2 or Orange Red No.2 (the first method in Appendix ⅸ A of Pharmacopoeia 20 10).
5.7.3 Take 2.0g of this product as chloride, add water 100ml, heat and dissolve, cool and filter, take 25ml of filtrate, and check it according to law (Appendix VIII A of Pharmacopoeia II, 20 10 edition). Compared with the control solution made of 5.0ml standard sodium chloride solution, it shall not be thicker (0.0 1).
5.7.4 Take 25ml of residual filtrate under sulfate chloride and check it according to law (Appendix VIII B of Pharmacopoeia Part II, 20 10). Compared with the control solution made of standard potassium sulfate solution 1.0ml, it should not be more concentrated (0.02%).
5.7.5 New system for clinical use of p-aminophenol and related substances. Take an appropriate amount of this product, weigh it accurately, and add solvent [methanol-water (4: 6)] to make a solution containing about 20mg per 1ml as the test solution; In addition, an appropriate amount of para-aminophenol reference substance and para-acetaminophen reference substance are accurately weighed and dissolved in the above solvents to prepare a mixed solution containing about 1μg para-aminophenol and 20μg para-acetaminophen per 1ml reference substance solution. According to high performance liquid chromatography (20 10 version of Pharmacopoeia, Part II, Appendix ⅴ D). Octylsilane bonded silica gel is used as filler; Phosphate buffer (8.95g disodium hydrogen phosphate and 3.9g sodium dihydrogen phosphate, dissolved in water to 1000 ml, and added with 10% tetrabutylammonium hydroxide solution 12 ml) and methanol (90: 10) as the mobile phase; The detection wavelength is 245 nm; Column temperature 40℃; The theoretical plate number should be no less than 2000 calculated by acetaminophen peak, and the separation degree between acetaminophen peak and acetaminophen peak should meet the requirements. Take 20μl of reference solution, inject it into the liquid chromatograph, adjust the detection sensitivity, so that the peak height of the chromatographic peak of p-aminophenol is about 65438 00% of the full scale, then accurately measure 20μl of test solution and reference solution, inject them into the liquid chromatograph respectively, and record the chromatogram until the retention time of the main component peak reaches 4 times; If there is a chromatographic peak in the chromatogram of the test sample that is consistent with the retention time of p-aminophenol in the reference solution, according to the external standard method, the content of p-aminophenol shall not exceed 0.005% in terms of peak area; The peak area of other impurities shall not be larger than that of acetaminophen in the control solution (0. 1%); The total amount of impurities shall not exceed 0.5%.
5.7.6 A new system for clinical use of p-chlorophenylacetamide. Take the test solution under p-aminophenol and related substances as the test solution; In addition, an appropriate amount of p-chlorophenylacetamide reference substance and acetaminophen reference substance are accurately weighed and dissolved in a solvent [methanol-water (4: 6)] to prepare a mixed solution [containing 1 μ g of p-chlorophenylacetamide and 20 μ g of acetaminophen per 1 ml] as a reference solution. According to high performance liquid chromatography (20 10 version of Pharmacopoeia, Part II, Appendix ⅴ D). Octylsilane bonded silica gel is used as filler; Using phosphate buffer (8.95g disodium hydrogen phosphate and 3.9g sodium dihydrogen phosphate, dissolved in water to 1000 ml, and adding 10% tetrabutylammonium hydroxide 12 ml) methanol (60: 40) as the mobile phase; The detection wavelength is 245 nm; ; Column temperature 40℃; The theoretical plate number is not less than 2000 calculated by acetaminophen peak, and the separation degree of acetaminophen peak and acetaminophen peak should meet the requirements. Take 20μl of reference solution, inject it into the liquid chromatograph, adjust the detection sensitivity so that the peak height of the chromatographic peak of p-chlorophenylacetamide is about 65438 00% of the full range, then accurately measure 20μl of test solution and reference solution, inject them into the liquid chromatograph respectively, and record the chromatogram; According to the external standard method, the content of p-chlorophenylacetamide should not exceed 0.005% in terms of peak area.
5.7.7 loss on drying takes this product and dries it to constant weight at 105℃, and the weight loss shall not exceed 0.5% (Appendix VIII L of Pharmacopoeia II, 20 10).
5.7.8 residue on ignition shall not exceed 0. 1% (Appendix VIII N of Pharmacopoeia II, 20 10).
5.7.9 Take 0.0g of this product 65438+ heavy metal, add 20ml of water, heat it in a water bath to dissolve it, let it cool, filter it, take the filtrate, add 2ml of acetate buffer (pH 3.5) and appropriate amount of water to make 25ml, and check it according to law (the first method in Appendix VIII H of Pharmacopoeia Part II, 20 10). The content of heavy metal shall not exceed ppm.
5.8 Content determination Take about 40mg of this product, accurately weigh it, put it in a 250ml volumetric flask, add 50ml of 0.4% sodium hydroxide solution to dissolve it, add water to the scale, shake it well, accurately measure 5ml, put it in a 100ml volumetric flask, add 0.4% sodium hydroxide solution 10ml, add water to the scale, shake it well, and take photos.
5.9 antipyretic and analgesic drugs.
5. 10 storage and sealed preservation.
5. 1 1 preparation (1) acetaminophen tablets? (2) Acetaminophen chewable tablets? (3) Acetaminophen effervescent tablets? ④ Acetaminophen injection? (5) Paracetamol suppository (6) Paracetamol capsule? (7) Paracetamol granules (8) Paracetamol drops? (9) acetaminophen gel
5. 12 Edition People's Republic of China (PRC) Pharmacopoeia 20 10 Edition
6 paracetamol instructions 6. 1 drug name paracetamol
6.2 English names are paracetamol, acetaminophen, Fortolin, Panodol, Snaplets, Sufferin, Tylenol.
6.3 Paracetamol, another name for acetaminophen; Acetaminophen; Acetaminophen; Baifuning; Biliton; Tylenol; Hitachi Qing; A drop of clear; Antipyretic net; Selin' an; Tylenol analgesic tablets; Yasida; Snape; acetaminophen
6.4 classification of nervous system drugs >: analgesic-antipyretic
6.5 dosage form 1. Flat plate: 0. 1g, 0.3g, 0.5g；;
2. Chewable tablets (Baifuning Chewable Tablets):160mg; ;
3. Diaphragm:160mg; ;
4. Controlled release tablets: 650mg；;
5. Particles:160mg; ;
6. Effervescent granules: 0. 1g, 0.5g；;
7. Oral liquid: 32m g/ml；; ;
8. Drops: 100 mg (1 ml);
9. Syrup: 50mg (1 ml);
10. Anjia hot syrup: 24 mg (1ml);
1 1. Xiaoer antipyretic suppository: 125mg, 300mg.
12. compound preparation: (1) compound acetaminophen tablets: each tablet contains acetaminophen 0. 126g, aspirin 0.23g and caffeine 0.03g; (2) Baifuning tablets (film-coated tablets): 0.5g；; (3) Saridon tablets: each tablet contains 250mg of acetaminophen, ipratropium 150mg and 50mg of caffeine.
6.6 Pharmacological Effects of Acetaminophen Acetaminophen is an acetanilide antipyretic and analgesic drug, which is the metabolite of phenacetin in the body. Its analgesic mechanism is not very clear, and it may be produced by inhibiting prostaglandin synthesis (including prostaglandin synthase) in the central nervous system and blocking the impulse of pain nerve endings. Its effect of blocking the impulse of nociceptive nerve endings may be related to inhibiting the synthesis of prostaglandin or other substances that can make nociceptors sensitive (such as serotonin and bradykinin). Acetaminophen has antipyretic effect by affecting the thermoregulatory center of hypothalamus, which may be related to the inhibition of prostaglandin synthesis in hypothalamus. Acetaminophen has a strong antipyretic effect, similar to aspirin, and lasts for a long time, but its analgesic and anti-inflammatory effects are weak, and low doses are ineffective for rheumatism. This is because acetaminophen has a strong inhibitory effect on the synthesis and release of prostaglandin in dorsal thalamus, but it has a weak inhibitory effect on the synthesis and release of prostaglandin in peripheral thalamus. Therefore, acetaminophen can not replace aspirin or other non-steroidal anti-inflammatory drugs to treat various types of arthritis, but it can be used in cases that are allergic to aspirin, intolerant or unsuitable for aspirin, such as bleeding diseases such as chicken pox and hemophilia (including anticoagulant therapy), as well as peptic ulcer and gastritis. Acetaminophen should be used for treatment, and other therapies should be used to relieve the cause of pain or fever if necessary. Aspirin drugs (such as aspirin, acetaminophen, ibuprofen, etc. ) has a protective effect on preventing cataracts.
6.7 Pharmacokinetics of Acetaminophen Acetaminophen is absorbed rapidly and completely by oral administration, and it is evenly distributed in body fluids, reaching its peak 0.5-2 hours after oral administration, and the action lasts for 3-4 hours. About 25% of them bind to plasma protein, but a small amount (blood concentration less than 60μg/ml) does not bind to protein obviously. The binding rate of large or toxic dose to protein is high, up to 43%. 90% ~ 95% of acetaminophen is metabolized in the liver, about 60% is bound to glucuronic acid, and the rest is bound to sulfuric acid and cysteine. Intermediate metabolites have toxic effects on the liver. T 1/2 is 2 ~ 3 hours, which can be prolonged by 1 ~ 2 times when liver function declines. It is also prolonged in the elderly and newborns, but shortened in children. Acetaminophen is mainly excreted from the kidney in the form of glucuronic acid conjugate, and about 3% is excreted with urine in the original form within 24 hours. Under normal circumstances, glutathione can be combined with detoxification in the liver. When acetaminophen is used in excess, the storage of glutathione is exhausted, and this metabolite is combined with hepatocyte macromolecules, thus causing liver necrosis.
6.8 Indications of acetaminophen 1. Used to treat colds and fever.
2. Arthralgia, neuralgia, headache, migraine, cancer pain and postoperative analgesia.
3. It is especially suitable for patients who are allergic or intolerant to aspirin, such as hemophilia, hemorrhagic diseases, patients receiving anticoagulant therapy, peptic ulcer, gastritis, etc.
6.9 Contraindications of acetaminophen 1. People who are allergic to acetaminophen are prohibited.
2. Newborns are prohibited.
6. 10 Precautions 1. (1) Liver disease or viral hepatitis: acetaminophen has the risk of increasing hepatotoxicity, so the risk of adverse reactions when suffering from liver disease increases. (2) Patients with renal insufficiency: it can be used occasionally, but if it is used in large quantities for a long time, there is a danger of increasing renal toxicity. (3) Patients with severe heart and lung diseases: The use of acetaminophen should be strictly controlled. (4) alcoholics. (5) Glucose 6- phosphate dehydrogenase 6- phosphate dehydrogenase deficiency Patients with 6- phosphate dehydrogenase deficiency: Acetaminophen hemolysis has been reported in such patients. (6) pregnant women.
2. Effects of drugs on children: Children under 3 years old and newborns should avoid using drugs because of liver and kidney dysfunction.
3. Effect of drugs on pregnancy: Acetaminophen can pass through the placenta, so pregnant women should consider the possible adverse effects on the fetus when using it.
4. Effect of drugs on test value or diagnosis: (1) Blood sugar determination: When measured by glucose oxidase/peroxidase method, a false low value can be obtained, but when measured by hexokinase /6- phosphate dehydrogenase method, it has no effect. (2) Determination of serum uric acid: Pseudo high value can be obtained by phosphotungstic acid method. (3) Determination of urine 5- hydroxyindoleacetic acid (5-HIAA): When qualitative screening test is carried out with nitroso-catechol reagent, false positive results can be obtained without affecting quantitative test. (4) Liver function test: Prothrombin time, serum bilirubin concentration, serum lactate dehydrogenase concentration and serum transaminase can all be increased by long-term use of large dose (above 8 ~ 10g) or small dose (above 3 ~ 5g per day). (5) Using YSI glucose analyzer will lead to false positive results.
5. Items that should be checked or monitored before and after medication: Liver and kidney functions should be checked before medication, and those with long-term large doses should be checked regularly (including hemogram, liver and kidney functions, etc. ).
6. Reaction of overdose: (1) When overdose (including toxic dose), symptoms such as pallor, loss of appetite, nausea, vomiting, stomachache or stomach cramp, diarrhea, aversion to eating, hyperhidrosis, etc. may appear quickly and last for 24 hours. Abdominal pain, hepatomegaly and tenderness, elevated transaminase and jaundice may occur within 0/~ 4 days. On the 4th to 6th day, obvious liver failure (fulminant liver failure) can appear, which is manifested by brain edema symptoms such as hepatic encephalopathy (mental disorder, disturbance of consciousness, restlessness and lethargy), flapping tremor, convulsion, respiratory depression and coma, as well as coagulation disorder, gastrointestinal bleeding, disseminated intravascular coagulation, hypoglycemia, acidosis, arrhythmia, circulatory failure, tubular necrosis and even death. (2) Some patients have atypical manifestations, only abdominal pain, metabolic acidosis or coma, hyperventilation and respiratory depression. About 12% of patients with overdose have renal failure, but not all patients are accompanied by liver failure. (3) There have been reports of myocardial damage caused by overdose.
7. Overtreatment: (1) induce vomiting and gastric lavage to reduce drug absorption. Use medicinal charcoal to absorb drugs in the ear after gastric lavage, but it should be noted that medicinal charcoal will also affect the absorption and curative effect of oral acetylcysteine. (2) Acetylcysteine should be used as soon as possible, and it is most effective to use it within 10 ~ 12h after overdose. Oral administration of 140mg/kg was started, and then the dosage was 70mg/kg every 4 hours 1 time, for a total of 17 times; When the condition is serious, the drug can be dissolved in 20 ml of 5% glucose injection for oral administration. (3) If acetylcysteine cannot be used within 24 hours after overdose of acetaminophen, hemodialysis or hemoperfusion may be beneficial to remove acetaminophen from the blood circulation, but the effect of this treatment on preventing its hepatotoxicity is still unclear. (4) The plasma concentration of acetaminophen should be monitored at least 4 hours after overdose, and premature determination is not helpful to reliably evaluate the potential hepatotoxicity. Liver function examination includes: serum aspartate aminotransferase, alanine aminotransferase, prothrombin time and bilirubin quantification, which should be measured/kloc-0 every 24 hours for at least 96 hours. If there is no abnormal test value within 96h, there is no need to check again. Renal function and cardiac function examination depend on clinical needs. (5) Support therapy: maintain water-electrolyte balance, correct hypoglycemia, supplement vitamin K 1 1 (such as prothrombin time ratio greater than 1.5) or use fresh frozen plasma and concentrated coagulation factors (such as prothrombin time ratio greater than 3.0).
6. 1 1 adverse reaction of acetaminophen 1. Acetaminophen has little gastrointestinal effect, and short-term use will not cause gastrointestinal bleeding. However, several cases of hepatotoxicity caused by acetaminophen have been reported, even leading to liver failure and liver necrosis. Alcoholism may aggravate hepatotoxicity.
2. Urinary system: Long-term high-dose acetaminophen can cause renal diseases, including renal necrotizing renal failure, especially patients with low renal function, renal colic or acute renal failure (oliguria, uremia). Renal failure may also be secondary to liver damage caused by acetaminophen.
3. Blood system: rare adverse blood reactions, and occasional reports of thrombocytopenia (including immune thrombocytopenia). Other rare adverse blood reactions include hemolytic anemia, agranulocytosis, pancytopenia, plasmacytosis, thrombocytosis, chronic myeloid leukemia and chronic lymphocytic leukemia. Compared with aspirin, acetaminophen has little effect on bleeding time and platelet aggregation time.
4. Endocrine/Metabolism: Foreign animal experiments have found that high-dose acetaminophen can inhibit thyroid function and * * * production, but its clinical relationship is still uncertain. There are reports of hypothermia and metabolic acidosis caused by overdose abroad. Poisoning dose can lead to hypophosphatemia and hypoglycemia, and there have been reports of transient hyperglycemia.
5. Skin: urticaria, fixed drug eruption and occasional pruritic dermatitis may occur. There are reports of vascular purpura, acute systemic herpetic pustulosis and maculopapulosis abroad. Rare toxic epidermal necrosis and dissolution.
6. Skeletal muscle: There are reports of rhabdomyolysis caused by paracetamol abroad.
7. Allergic reactions are rare.
8. No carcinogenic effect has been reported.
6. Usage and dosage of12 paracetamol 1.0.5 ~ 1.0g, 3 ~ 4 times a day.
2. Dosage for children: 6 ~ 12 years old, 0.25~0.5g orally each time, 3 ~ 4 times a day. Do not use for children under 6 years old.
3. Adults and children can also use suppositories.
6. 13 drug interaction 1. Acetaminophen can inhibit the metabolism of nitrocoumarin acetate or interfere with the formation of blood clots, thus enhancing the anticoagulant effect of nitrocoumarin acetate.
2. Acetaminophen can inhibit the metabolism of warfarin or hinder the formation of blood clot contraction factor, thus increasing the risk of bleeding caused by warfarin.
3. When diflunisal is combined with acetaminophen, the plasma concentration of acetaminophen increases by about 50%, which is reported to cause hepatotoxicity. The plasma concentration of diflunisal remained unchanged.
4. The combination of fenodopam and acetaminophen can increase the plasma concentration of fenodopam by 30% (short-term use) and 70% (long-term use); The AUC of fenodopam increased by 50% (short-term use) and 66% (long-term use). The metabolite content and AUC of fenodopam decreased. No adverse reactions were reported in short-term combined medication.
5. Methyl pyridone can inhibit the formation of acetaminophen glucuronic acid conjugate, thus increasing the risk of acetaminophen poisoning.
6. When sulfapirone is combined with acetaminophen, the metabolism of acetaminophen increases, and its toxicity to the liver also increases.
7. Acetaminophen can promote the removal of lamotrigine from blood, thus reducing the curative effect of lamotrigine.
8. Phenytoin sodium and phenytoin sodium can increase the metabolism of acetaminophen in the liver, reduce the curative effect of acetaminophen and increase the hepatotoxicity.
9. Acetaminophen reduces glutathione, and busulfan is excreted by combining with glutathione, so when they are used together, the renal clearance rate of busulfan decreases.
10. Ureazine is a liver enzyme inducer. When used with acetaminophen in large doses and frequently, it can strengthen acetaminophen metabolism and increase hepatotoxic products.
1 1. Sphingosine can reduce the absorption of acetaminophen and weaken the therapeutic effect of acetaminophen.
12. tizanidine (muscle relaxant) can delay the peak time of acetaminophen when taken orally, but its clinical significance is unknown.
13. isoniazid can increase the hepatotoxicity of acetaminophen.
14. acetaminophen may change the pharmacokinetics of chloramphenicol (the specific effects are reported differently). When they are used together, it may increase the toxicity of chloramphenicol, leading to vomiting, hypotension and hypothermia.
15. When combined with the antiviral drug zidovudine, the combination of the two drugs with glucuronic acid can be reduced, and the clearance rate can be reduced, thus increasing the toxicity, so simultaneous application should be avoided.
16. antacids can significantly delay the peak time of acetaminophen plasma concentration, but have no effect on the average plasma peak concentration, maximum plasma peak concentration and half-life of acetaminophen.
17. After zolmitriptan was combined with acetaminophen, the plasma concentration of zolmitriptan increased slightly, but it had no clinical significance.
18. acetaminophen may increase the plasma concentration of ethinylestradiol, while oral contraceptives can reduce acetaminophen.
19. Long-term large-scale combination with aspirin, other salicylate preparations or other non-steroidal anti-inflammatory drugs (for example, the annual cumulative dose reaches 1000g, which can obviously increase the toxicity to the kidney (including renal necrosis, renal and bladder tumors, etc.). ).
20. When acetaminophen is combined with antihypertensive drugs (such as atenolol), there is no obvious change in antihypertensive effect.
2 1. Excessive use of acetaminophen by long-term alcoholics has greater hepatotoxicity than non-alcoholics, resulting in more toxic metabolites of acetaminophen.
22. Food can slow down the absorption of acetaminophen and reduce its peak concentration.
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6. 14 expert comments have strong antipyretic and analgesic effects on acetaminophen, but weak anti-inflammatory and anti-rheumatic effects. Its antipyretic effect is similar to aspirin, but its analgesic effect is weaker than aspirin. It has little effect on gastrointestinal tract, platelets and coagulation mechanism. There are many kinds of compound preparations in clinic, which are widely used for antipyretic and analgesic treatment.
7 Paracetamol Poisoning Paracetamol (paracetamol) is the active metabolite of non-Naxi Ding, which has good antipyretic and analgesic effects and has no effect on platelet and coagulation mechanism. 0.5 ~ 2 hours after the drug was taken orally, the plasma concentration reached the peak, and the plasma protein binding rate was 25% ~ 50%. After a large amount of intake, it can be delayed to 4 hours, and 90% is metabolized by the liver.12 hours suggests the possibility of hepatic encephalopathy. The common dosage of this drug is 0.3 ~ 0.6g/ time, 2 ~ 3 times /d, the toxic dosage for adults is 7.5g, the lethal dosage is 5 ~ 20g, the toxic blood concentration is 15mg/dl, and the lethal blood concentration is 150mg/dl. The toxic dose of children was 1.50 mg/kg. It mainly damages the liver, kidneys and blood system, with occasional allergic reactions. [2]
7. 1 clinical manifestations [2]
1. Adverse reaction? Less, nausea, vomiting, sweating, abdominal pain, pale face, occasional allergic reactions such as thrombocytopenia and leukopenia, occasional urticaria, dermatitis and bronchospasm.
2. Acute poisoning? It mainly causes liver and kidney damage.
(1) Liver damage: manifested as loss of appetite, nausea, vomiting, tenderness in the right upper abdomen, jaundice, increased serum bilirubin and transaminase, prolonged prothrombin time, and severe cases may lead to mental symptoms such as hepatic encephalopathy, mental disorder and inattention.
(2) Renal damage: proteinuria, tubular urine, hematuria, oliguria, anuria, etc.
3. Laboratory inspection
(1) Detection of drug concentration in plasma is helpful for diagnosis and prognosis.
(2) Detection of liver function and prothrombin time.
7.2 The treatment points of acetaminophen poisoning are [3]:
1. Excessive vomiting, gastric lavage with 0.45% normal saline and catharsis with magnesium sulfate.
2. Apply the antidote acetylcysteine 140mg/kg, dissolve it in 300ml 5% glucose solution, and then use 70mg/kg every 4 hours until 72h.
3. Early, short-term and sufficient application of glucocorticoid, such as hydrocortisone and dexamethasone.
4. According to the severity of liver and kidney damage, hemodialysis, hemoperfusion, blood exchange and other methods can be used to remove poisons.