Paracetamol and Hepatitis C

[philslat]

Had a call recently that came in as possible flu like symptoms. Pre arrival was nausea and vomiting, increasing lethargy, leg pain, and onset of shaking ? rigors

The patient in question was post OP x 6 weeks liver surgery removal of tumors. Other co comorbidities included chf, hep c and lung fibrosis

Anyhow it turned out he was apyrexic, and had what appeared to be cellulitis in his left leg a source of previous episodes of sepsis but not hitting markers on examination

My question is if the patient had been pyrexic would his liver surgery and hep c make him contraindicated for paracetamol administration

Thanks




pypyrexewould he

 

[VFlutter]

Recommendations for Acetaminophen in patients with chronic Hep C is 2g max per day or 1g max per day with cirrhosis. If patient was significantly febrile I would think it is still indicated. Just make sure the receiving facility is aware so they do not give more. Or depending on transport time just defer until the ER.

 

[Akulahawk]

For EMS, one of the things you can do when you get these patients is find out if they've taken paracetamol, and if so, how much. Same with any NSAID as well. As an ED RN, if I know my patient has various comorbidities and has taken an antipyretic medication recently, that can help me keep my patient safe if the provider orders additional medication.

In evaluating a septic patient, if I know that my patient is generally afebrile but has taken an antipyretic medication recently, that makes me want to watch them more closely and also watch for other signs of sepsis as one of the signs for SIRS/Sepsis would be masked.

 

[Peak]

Keep in mind that a acutly toxic dose in a patient with no liver disease is several times greater that the maximum prescribed dosing, and acute toxicities are very rare unless the result of intentional overdose.

Largely the pathophysiology of hepatitis has different enzyme pathways than of acetaminophen metabolism. Most well managed hepatitis patients who are not consuming large amounts of alcohol tolerate acetaminophen pretty well, although we certainly recommend smaller doses than the general population. If presented quickly to the ED even substantial intentional overdoses tend to recover pretty well with NAC.

Our liver transplant attending does a whole presentation for the critical care teams. He essentially likes to say that despite patients claims that either hepatitis and mild alcohol consumption or hepatitis and ordinary acetaminophen used rarely causes any significant degree of failure, let alone death or need for transplant.

Fever control can be controlled via means other that APAP whether that be NSAIDS, environmental, or other medications/therapies.