The BMJ Learning online course “Paracetamol overdose: interactive case histories” (link attached) writes
“When assessing patients with clinically significant paracetamol poisoning, you should also measure INR, Full blood count, Liver function tests, Plasma glucose, Serum electrolytes including bicarbonate and lactate, Arterial blood gases” (section 4 of 13).
It does not explain, however, the following: What to look for when checking the FBC result? What action to take in what case?
http://learning.bmj.com/learning/module-intro/paracetamol-overdose-management.html?moduleId=5003234&locale=en_GB
Following articles might help you.
Kind regards, Matheus Arts
Article:
J R Thornton, M S Losowsky. Severe thrombocytopenia after paracetamol overdose. Gut, 1990:31;1159-1160.
Full blood count showed a severe acute thrombocytopenia. A moderate reduction in platelet count is common in acute liver failure.
Article:
Wright RO et al. Hemolysis after acetaminophen overdose in a patient with glucose-6-phosphate dehydrogenase deficiency. J Toxicol Clin Toxicol 1996;34(6):731-734.
Article:
Makin A, Williams R. Paracetamol hepatotoxicityand alcohol consumption in deliberate and accidental overdose.Q J Med 2000;93:341-349.
Article:
Leach M et al. Acute liver failure induced by alcohol and paracetamol in an HCV-infected haemophiliac. British Journal of Haematology 1998:103;891–893.
Excellent point. Do the term evidence based medicine and approprpriate We often do "routine" investigations, a term I dislike greatly although it does provide a baseline reference. One important situation in paracetamol overdose is the patient who presents late with coagulopathy secondary to fulminant hepatic failure even though this is a tiny number of patients.
Some people like to take bloods or have bloods taken on them and seem reassures when all is normal despite the fact that they were never going to be abnormal except in a subset of this population
Richard
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