A 17-year-old girl presented with jaundice three days after having taken a paracetamol and alcohol overdose during an argument with her boyfriend.
What is the best marker of prognosis?
a. Serum aspartase transaminase.
b. Serum alkaline phosphatase.
c. Serum bilirubin.
d. Prothrombin time.
e. Paracetamol level.
Answer:
d. Prothrombin time.
Discussion:
Important risk markers for severe hepatic injury after paracetamol overdose include:
- a PT >20 seconds 24 h after ingestion,
- pH <7.3 and
- creatinine >300 micromol/l.
The three most important prognostic markers in paracetamol overdose are serum creatinine concentration, arterial pH and prothrombin time.
A rise in serum creatinine level due to renal failure is a bad prognostic sign. A level of over 300 mmol/l is associated with over 70% mortality.
Systemic acidosis (due to the failure of clearance of lactate by the liver) more than 24 hours after
the overdose is associated with a poor prognosis. A pH of below 7.3 is associated with only a 15% chance of survival.
The PT is usually the first liver test to become abnormal. A PT of >20 s at 24 hours after overdose is suggestive of significant hepatic damage, and a peak PT of >180 s is associated with a 90% mortality.
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