A 23-year-old woman presents to the Emergency Department some 48hrs after consuming 30x500mg paracetamoltablets She has begun to vomit and her friend told her she has yellow eyes. She takes the oral contraceptive pill and drinks 5 pints of strong lager per day. On examination her BP is 95/70 mmHg, pulse IS 80/min and regular. She has jaundiced sclerae. Abdomen is soft. with tenderness in the right upper quadrant Which of the following findings would be the most reliable indicator of poor prognosis in this case?
A ALT >4x upper limit of normal (ULN)
B Creatinone 122 micromolll
C Elevated bilirubin
D Glucose 9.1 mmol/1
E.INR 2.2
Explanion
INA >2.0 at or before 48 hours or >3.5 at or before 72 hours is indicative of poor outlook in paracetamol overdose, supponing referral to a specialist unit. Peak elevation occurs at the 72-96hrs stage Where INA is >6.5, referral for hver transplantation should be considered.
ALT>4x ULN, (Option A), is incorrect. Liver function tests are a poor predictor of outcome in paracetamol overdose.
I)
Creatinine 122 micromol/1, (Option B), is incorrect. Serum creatinine of 200 or higher is considered an indication for specialist referral. For creatinine >400, dialysis is usually considered
Elevated bilirubin, (Option C), is incorrect. Although elevated bilirubin is an indicator of hepatic dysfunction, it is less predictive of poor outcome than abnormal clotting.
Glucose 9.1 mmol/1, (Option D), is incorrect. Hypoglycaemia, not hyperglycaemia is an indicator of poor prognoSIS in patients with paracetamol overdose.