In this chapter, we have discussed the paracetamol-induced hepatotoxicity, pathophysiology, and factors that increase the risk of its toxicity, prevention, treatment, and patient outcome. Some patients with liver failure require liver transplantation for survival. It has now been recognized that paracetamol toxicity consists of multiple pathways, including paracetamol metabolism, o xidative stress, endoplasmic reticulum stress, autophagy, sterile inflammation, microcirculatory dysfunction, and compensatory liver repair and regeneration. N-acetyl cysteine (NAC) is used as an antidote for paracetamol-overdosed patients however, it should be administered as early as possible. A lot of research has been conducted to know the pathogenesis of paracetamol-induced liver toxicity. Paracetamol is relatively safe compared with other NSAIDS however, overdose can cause a spectrum of liver injuries from mild elevation in liver enzymes to acute liver failure and encephalopathy. Paracetamol is one of the most commonly used drugs as an analgesic and antipyretic, it is a structural analog of phenacetin, which was withdrawn due to concerns for nephrotoxicity. There are two sets of enzymes, phase I and phase II enzymes which play a very important role in the metabolism and detoxification of various drugs and other toxins. Liver damage may occur due to environmental toxicants, drugs, and microbial metabolites. ![]() ![]() The production of oxidants is the most common action in the pathogenesis of liver damage by pharmaceutical drugs and herbal products. Metabolization of drugs and xenobiotics to nontoxic substances in the liver by enzymes is important for the proper function of the body, alteration in these statuses leads to a shift of metabolism toward the production of oxidants, which coheres to lipids or nuclear proteins which results in mutations, membrane damage, and alteration of enzyme activity respectively which further leads to organ malfunction. ![]() The liver contributes significantly to the metabolism and removal of drugs from the human body.
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