By Woodfield et al.
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One of these (involving CYP450 enzymes which usually only play a minor role in paracetamol metabolism) results in the production of a toxic metabolite called NAPQI (N-acetyl-p-benzo-quinoneimine). When therapeutic doses of paracetamol are taken, the smalls amounts of NAPQI produced are quickly detoxified by glutathione. However, in paracetamol overdose more NAPQI is produced and glutathione stores are depleted until NAPQI can no longer be detoxified. NAPQI then binds to hepatocytes causing necrosis.
12/02/1994 FORENAME, SURNAME Carey Patterson ADDRESS 2A, Southampton Street NHS NUMBER SALBUTAMOL (100 micrograms per dose), inhaled. Take 2 puffs as required. BECLOMETASONE (100 micrograms per dose), inhaled. Take 2 puffs twice a day. MICROGYNON 30, oral. Take as directed. SIGNATURE OF PRESCRIBER DATE SP21000 Chapter 2: Emergency Department / 17 Diagnosis This patient has anaphylaxis (a severe allergic reaction) and has either been re-exposed to the allergen that triggered her initial episode or is experiencing the recurrence of symptoms, which is sometimes seen several hours after exposure, a so-called ‘biphasic reaction’.
AMLODIPINE tablets, oral, 5 mg once daily. Case study Presenting complaint: Mr Stevenson was admitted via the Emergency Department yesterday having fallen at home. He has been seen by the orthopaedic team who confirmed a fractured pubis ramus, requiring a period of rehabilitation at a local community hospital. One of the nurses asks you to come and see him as he is starting to act strangely. PMH: Hypertension, TIA DH: See FP10 Allergies: Nil known SH: Retired carpenter, lives alone, usually mobilises independently, ex-smoker; alcohol intake: 1 bottle of wine per night.