2. Refer to the conventional strength of Tylenol in English (including Tylenol painkillers)
Conventional strength of Tylenol (including acetaminophen, pseudoephedrine hydrochloride, dextromethorphan hydrobromide and chlorphenamine maleate)
Tylenol Zhitong Tablet is the active metabolite of Naxi Ding, a antipyretic and analgesic drug, which is 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.
4 Pharmacopoeia standard Tylenol analgesic tablets 4. 1 product name 4. 1. 1 Chinese name Tylenol analgesic tablets
4. 1.2 Chinese Pinyin Pair Line' Anji Score'
4. 1.3 English name paracetamol
4.2 Structural Formula 4.3 Molecular Formula and Molecular Weight C8H9NO2? 15 1. 16
4.4 Source (name) and content (potency) This product is 4' hydroxyacetanilide. Calculated by dry product, the content of C8H9NO2 should be 98.0% ~ 102.0%.
4.5 Properties 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.
4.5. 1 melting point The melting point of this product (Appendix C of Pharmacopoeia II, 20 10) is 168 ~ 172℃.
4.6 Identification (1) The aqueous solution of this product is 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).
4.7 Check the acidity of 4.7. 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.
4.7.2 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).
4.7.3 Chloride Take 2.0g of this product, add 65438+5.0ml of water, 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 standard sodium chloride solution, it shall not be thicker (0.0 1).
4.7.4 Take 25ml filtrate and leave it under chloride for sulfation, and check it according to law (Appendix VIII B of Pharmacopoeia II, 20 10). Compared with the control solution made of standard potassium sulfate solution 1.0ml, it should not be more concentrated (0.02%).
4.7.5 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 p-aminophenol reference substance and Tylenol analgesic tablet reference substance were accurately weighed and dissolved in the above solvents to prepare a mixed solution containing about 65438 0 μ g of p-aminophenol and 20μg of Tylenol analgesic tablet per 65438±0ml as 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 according to Tylenol analgesic peak, and the separation degree between p-aminophenol peak and Tylenol analgesic 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 greater than that of the control solution (0. 1%). The total amount of impurities shall not exceed 0.5%.
4.7.6 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, a proper amount of reference substances of p-chlorophenylacetamide and Tylenol painkiller tablets were accurately weighed and dissolved in the solvent [methanol-water (4: 6)] to prepare a mixed solution of 20 micrograms of p-chlorophenylacetamide and Tylenol painkiller tablets per 1 ml [1 microgram] as 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; 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℃; According to the peak of Tylenol painkiller, the theoretical plate number should be not less than 2000, and the separation between the peak of p-chlorophenylacetamide and the peak of Tylenol painkiller 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.
4.7.7 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 Part II, 20 10).
4.7.8 residue on ignition shall not exceed 0. 1% (Appendix VIII N of Pharmacopoeia II, 20 10).
4.7.9 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 acetic acid 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), and the content of heavy metal shall not exceed ppm/kl.
4.8 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.
4.9 antipyretic and analgesic drugs.
4. 10 storage and sealed preservation.
4. 1 1 preparation (1) Tylenol analgesic tablets? (2) Tylenol painkiller chewable tablets? (3) Tylenol analgesic effervescent tablets? (4) Tylenol analgesic injection? (5) Tylenol analgesic suppository (6) Tylenol analgesic capsule? (7) Tylenol analgesic granules (8) Tylenol analgesic drops? (9) Tylenol Zhitong Gel Tablets
4. 12 Edition People's Republic of China (PRC) Pharmacopoeia 20 10 Edition
5 Tylenol Painkiller Instructions 5. 1 Drug Name Tylenol Painkiller
5.2 English names paracetamol, acetaminophen, Fortolin, Panodol, Snaplets, Sufferin, Tylenol.
5.3 Tylenol painkiller alias paracetamol; Acetaminophen; Acetaminophen; Baifuning; Biliton; Tylenol; Hitachi Qing; A drop of clear; Antipyretic net; Selin' an; Acetaminophen; Yasida; Snape; acetaminophen
5.4 classification of nervous system drugs >: analgesic-antipyretic
5.5 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 Tylenol analgesic tablets: each tablet contains Tylenol analgesic tablets 0. 126g, aspirin 0.23g and caffeine 0.03g; (2) Baifuning tablets (film-coated tablets): 0.5g；; (3) Saridan tablets: each tablet contains Tylenol analgesic 250mg, ipratropium 150mg and caffeine 50mg.
5.6 Pharmacology of Tylenol Analgesic Tablets Tylenol Analgesic Tablets 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). Tylenol analgesic tablets can exert antipyretic effect by affecting the thermoregulatory center of inferior colliculus, which may be related to inhibiting the synthesis of prostaglandin in inferior colliculus. Tylenol Zhitong tablet has strong antipyretic effect, similar to aspirin, and its effect is lasting, but its analgesic and anti-inflammatory effect is weak, and low dose is ineffective for rheumatism. This is because Tylenol Zhitong tablet 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, Tylenol analgesic tablets can not replace aspirin or other non-steroidal anti-inflammatory drugs in the treatment of various types of arthritis, but can be used in cases that are allergic to aspirin, intolerant or unsuitable for aspirin, such as varicella, hemophilia and other hemorrhagic diseases (including anticoagulant therapy), as well as peptic ulcer and gastritis. Tylenol analgesic tablets 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, Tylenol painkillers, ibuprofen, etc. ) has a protective effect on preventing cataracts.
5.7 Pharmacokinetics of Tylenol Analgesic Tablets Tylenol Analgesic Tablets are absorbed rapidly and completely by oral administration, and distributed evenly in body fluids, reaching the peak value 0.5-2h after oral administration, and the action lasts for 3-4h. 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%. Tylenol analgesic tablets are 90% ~ 95% metabolized in the liver, about 60% are bound to glucuronic acid, and the rest are 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. Tylenol analgesic tablets are mainly excreted from the kidney in the form of glucuronic acid conjugates, and about 3% of them are excreted in urine within 24 hours. Under normal circumstances, glutathione can be combined with detoxification in the liver. When Tylenol Zhitong tablet is used excessively, it is exhausted because of glutathione storage, and this metabolite combines with hepatocyte macromolecules, thus causing liver necrosis.
5.8 Indications of Tylenol Analgesic Tablets 1. It is 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.
5.9 The contraindication of Tylenol Analgesic Tablets is 1. It is forbidden for people who are allergic to Tylenol painkillers.
2. Newborns are prohibited.
5. 10 Precautions 1. (1) Liver disease or viral hepatitis: Tylenol Zhitong tablets have the risk of increased 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 Tylenol painkillers should be strictly controlled. (4) alcoholics. (5) Patients with glucose 6- phosphate dehydrogenase 6- phosphate dehydrogenase deficiency: It has been reported that Tylenol Zhitong tablets were hemolyzed by 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: Tylenol analgesic tablets can pass through the placenta, and pregnant women should consider the possible adverse effects on the fetus when using them.
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 Tylenol painkillers, hemodialysis or hemoperfusion may be beneficial to clear Tylenol painkillers from the blood circulation, but the effect of this treatment on preventing its hepatotoxicity is still unclear. (4) Monitoring the blood concentration of Tylenol Zhitong tablets should be carried out 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).
5. 1 1 Adverse reactions of Tylenol painkillers 1. Tylenol analgesic tablets have little effect on gastrointestinal tract, and short-term use will not cause gastrointestinal bleeding. However, there have been several reports about Tylenol Zhitong tablets causing hepatotoxicity, even causing liver failure and liver necrosis. Alcoholism may aggravate hepatotoxicity.
2. Urinary system: Long-term high-dose Tylenol painkillers can cause nephropathy, including renal necrotizing renal failure, especially in patients with low renal function, renal colic or acute renal failure (oliguria, uremia). Liver damage caused by Tylenol Zhitong tablets may also lead to renal failure.
3. Blood system: rare adverse blood reactions, with 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, Tylenol has little effect on bleeding time and platelet aggregation time.
4. Endocrine/Metabolism: Foreign animal experiments have found that high-dose Tylenol painkiller 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 Tylenol painkillers abroad.
7. Allergic reactions are rare.
8. No carcinogenic effect has been reported.
5. 12 Tylenol painkiller tablets: 1.0.5 ~ 1.0g, three to four 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.
5. 13 drug interaction 1. Tylenol analgesic tablets can inhibit the metabolism of nitrocoumarin acetate or interfere with the formation of blood clots, thus enhancing the anticoagulant effect of nitrocoumarin acetate.
2. Tylenol analgesic tablets 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 Tylenol Zhitong Tablets, the blood concentration of Tylenol Zhitong Tablets increases by about 50%, which has been reported to cause hepatotoxicity. The plasma concentration of diflunisal remained unchanged.
4. Fenodopam combined with Tylenol analgesic tablets can increase the blood 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. Merpirone can inhibit the formation of glucuronic acid conjugate of Tylenol Zhitong tablets and increase the risk of poisoning of Tylenol Zhitong tablets.
6. When sulfapirone is combined with Tylenol painkiller, the metabolism of Tylenol painkiller increases, and the toxicity to the liver also increases.
7. Tylenol analgesic tablets 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 Tylenol Zhitong tablets in the liver, reduce the curative effect of Tylenol Zhitong tablets and increase the hepatotoxicity.
9. Tylenol Zhitong tablets can reduce glutathione, while 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 Tylenol Zhitong tablets in large doses and frequently, it can strengthen the metabolism of Tylenol Zhitong tablets and increase hepatotoxic products.
1 1. Sphingosine can reduce the absorption of Tylenol painkillers and weaken the efficacy of Tylenol painkillers.
12. tizanidine (muscle relaxant) can delay the peak time of Tylenol analgesic tablets when taken orally, but its clinical significance is unknown.
13. isoniazid can increase the hepatotoxicity of Tylenol Zhitong tablets.
14. Tylenol painkiller tablets 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 Tylenol Zhitong tablets, but have no effect on the average peak blood concentration, maximum peak blood concentration and half-life of Tylenol Zhitong tablets.
17. After zolmitriptan was combined with Tylenol painkiller, the plasma concentration of zolmitriptan increased slightly, but it had no clinical significance.
18. Tylenol painkillers may increase the plasma concentration of ethinylestradiol, while Tylenol painkillers can reduce the plasma concentration through oral contraceptives.
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. Tylenol analgesic tablets combined with antihypertensive drugs (such as atenolol) have no obvious change in antihypertensive effect.
2 1. Excessive use of Tylenol Zhitong tablets by long-term alcoholics has greater hepatotoxicity than non-alcoholics, resulting in more toxic metabolites of Tylenol Zhitong tablets.
22. Food can slow down the absorption of Tylenol painkiller and reduce its peak concentration.
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5. 14 expert comments Tylenol Zhitong tablets have strong antipyretic and analgesic effects 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.
6 Tylenol painkiller poisoning Tylenol painkiller (paracetamol) is the active metabolite of phenacetin, which has good antipyretic and analgesic effects and has no effect on platelets 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]
6. 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.
6.2 The treatment points of Tylenol painkiller 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.