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Paracetamol Determination Lab Report
Introduction
Paracetamol, also known as acetaminophen, is an analgesic that regulates pain relief and reduces
fever (Graham et al., 2013). The chemical formula of paracetamol is C8H9NO2 (Graham eh al.,2013).
Acetaminophen is used in moderate amounts; the drug should only be used as directed on the label
or as the physician prescribes due to serious harm an overdose can cause to human health.
Paracetamol is often recommended for pain as side effects are rare and it also easily to access and
digested by the body (Paracetamol for adults: painkiller to treat aches, pains and fever, 2021). The
pharmacokinetics behind paracetamol begins with the gastrointestinal tract which absorbs the drug
from 30 minutes up to 2 hours (Paracetamol 500mg Tablets - Summary of Product Characteristics
(SmPC) - (emc), 2021). It is then metabolized in the liver and excreted in urine in the form of
glucuronides and sulphate conjugates. However, the rate of metabolism differs depending on age of
the patient (Paracetamol 500mg Tablets - Summary of Product Characteristics (SmPC) - (emc),
2021). In contrary to this, children and adults are prescribed different doses of paracetamol.
Normally, the average dose of paracetamol is 4g a day for adults, 1g dose every 4 hours
(Paracetamol: Uses, Dosage & Side Effects - Drugs.com, 2021). The major concerns for overdose of
acetaminophen are damage to liver, kidney, stomach and heart failure as these situations can lead
to death. Anaphylaxis is an allergic reaction to the drug itself however is it not very common but still
is a main concern (Paracetamol for adults: painkiller to treat aches, pains and fever, 2021). This is
why dosage restrictions are put in place. It is important to undergo a test for determining overdose
scenarios because we can identify the prognosis caused to health to intervene with treatment
appropriately.
In overdose case scenarios, the Rumak-Matthew nomogram is a strategy used by doctors universally
that calculates the need to intervene by a calculation of blood plasma levels over time of ingestion.
The strategy takes the time of ingestion into account as well as the absorbance of paracetamol
detected in the patient’s blood plasma. If the patient is above the treatment line, intervention
happens immediately. If the patient is below the treatment line, no intervention is needed although
the symptoms are taken into consideration so the patient may be kept under observation for
precaution. One method of intervention is ‘Activated Charcoal’ which slows the absorption rate of
paracetamol through the gut; this allows more paracetamol to be excreted in urine. In most
suspected overdose scenarios, activated charcoal is given. Furthermore, decreasing the rate of
absorption allows more time for the physician to conclude the next intervention to improve the
patient’s health. Consequently, hepatotoxicity is inhibited as the liver is not receiving paracetamol
oxidants. Another method of intervention is when ‘N-Acetylcysteine (NAC)’ is given to a patient to
promote the removal of reactive acetaminophen oxidants which averts blood poisoning and
neutralizes metabolites to prevent kidney damage. The Rumak-Matthew nomogram is used
worldwide to avoid damage to the patient’s liver while interfering when appropriate to do so.
In brief, this report will define the intervention needed for different overdose scenarios by using the
Rumak-Matthew nomogram to verify how much damage has been caused to the patient’s liver. On
the contrary, the data generated from the nomogram uses the patient’s blood plasma concentration
and the hours of how long it has been ingested. Using the nomogram allows the diagnosis of the
patients to be quicker resulting in more time to take action to the overdose scenarios. A further
insight is able to be conducted for what step to take next in the treatment process.
Methodology
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From the results recorded, the calibration curve was generated by calculating the average patient
samples collected. In this instance, the equation of the trendline was y=0.001x and the R2
value=0.9984. In order to construct the calibration curve, the data was gathered into a table
containing the absorbance and paracetamol concentration from where the mean was induced. The
calibration curve was proven to be accurate as the R2 value was above 0.95 proving the trendline to
be accurate. In addition to this, the gradient of the line 0.001 which means there is a positive
corelation deeming the results to be reliable. This enabled the calibration graph to be used for the
patient samples.
The bar chart consists of the mean and the standard deviation from the results conducted from the
patient’s blood plasma levels. To assess the reliability of the data, the standard deviation was
analysed as it shows how spread out the data is from the average value to corroborate if there were
any anomalies in the results documented. Using the low (100mg/ml) and high (300mg/ml) control
values and standard deviation, the original concentration of blood plasma levels were calculated
accordingly. As both concentrations were within a range of 30% (102.325% for low and 101% for
high) the values can be accepted in the graphical representation.
Results
The main aim of the lab report was to deduce whether the patients needed intervention and the
type of medication required, dependent on the paracetamol absorbance in their blood plasma. The
level of absorbance is then compared to the Rumak-Matthew nomogram to indicate whether or not
intervention is necessary to reduce the concentration of acetaminophen in their blood plasma.
The results obtained with reference to the Calibration Curve (Fig.A) were corroborated to be
evidently accurate due to the R2 value being above 0.95 as well as being close to the trendline which
means the results recorded were similar to the expected results. This point is supported by the data
illustrated in the table (Fig.B) as each range of concentration was within -/+ 30% of the original
calculation.
Figure A
A graph to show the amount of paracetamol absorbed
at different concentrations
0.6
0.5
f(x) = 0.00208614495277377 x − 0.0101251534375625
Absorbance of paracetamol
R² = 0.98231658961433
0.4
0.3
0.2
0.1
0
0 50 100 150 200 250 300
Paracetamol concentration (mg/ml)
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Figure B
Table One: Control data table
Low Control High control
Tube
100mg/ml 300mg/ml
0.09965 0.30105
Absorbance (@)
0.105 0.306
Calculated Con- 99.65 301.05
centration –
105 306
mg/ml
Average +/- SD 102.325+/-0.0036 303.525+/-0.0057
Calculated range
of original con- 102.33% 101%
centration
Within +/- 30%
range of original yes yes
concentration
Figure C
0.1
0.09
0.08
0.07
Absorbance @615
0.06
0.05
0.04
0.03
0.02
0.01
0
1 2 3 4 5
Patient Samples
Patient samples Mean Standard Deviation
Illustrated in Figure C is the bar chat where the standard deviation and mean of the patient samples
blood plasma concentration is displayed. The standard deviation highlights the consistency of the
data as the values are not far from the mean validating the accuracy of the data shown.
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From the results and information received about each patient, the intervention is only needed for
patient C due to the calculated value for the acetaminophen concentration being above the
treatment line on the Rumak-Matthew nomogram. This was calculated by multiplying the mean of
each patient’s blood plasma concentration by 0.002 to find the value for the concentration of
paracetamol in the patient’s blood plasma. The Rumak-Matthew nomogram made the intervention
evident for patient C.
Discussion
For each overdose case scenario presented, the Rumak-Matthew nomogram strategy was used to
determine the intervention needed for each patient. Applying the Rumak-Matthew method with the
results complied as presented in the results enabled the inference of whether administration of
treatment or any further intervention was needed. To figure out how much paracetamol had been
absorbed into the blood plasma, the mean value for the patient’s blood plasma was multiplied by
0.001 to equal the acetaminophen concentration. This was then complied onto the Rumak-Matthew
nomogram with the time of ingestion which was recorded when each patient was reviewed.
Patient A does not need any treatment despite symptoms as the calculated concentrated plasma
concentration was 86.55% and time of ingestion was 6 hours which meant that the point on the
Rumak-Matthew nomogram was far below the treatment line which means no intervention was
necessary. The symptoms of severe nausea and vomiting could be a sign of appendicitis or food
poisoning (Khatri, 2020). It is unlikely to be a heart attack because of the patients age and the
patient is still conscious.
Patient B requires immediate intervention of N-acetylcysteine as the calculated concentration was
above the treatment line with an acetaminophen level of 57.35% in the blood plasma after 12 hours
of ingestion. In addition to this, there was no history of blackouts or seizures which suggests that the
side effects of paracetamol did not display on the patient. Activated charcoal would be inadequate in
this scenario due to the time of administration.
Patient C does not necessitate any intervention as the value calculated is below the threshold of the
Rumak-Matthew nomogram at 5.5% for the paracetamol concentration after 8 hours of
administration. It is evident that there is a lack of paracetamol in the patient’s blood plasma hence
why the seizures could be health related. The patient may have epilepsy as it is common in
teenagers (Epilepsy (for Teens) - Nemours Kids Health, 2016).
Patient D had already received intervention of Activated charcoal upon arrival which resulted in
fatigue corroborated by the decreased rate of absorption of acetaminophen. Their fatigue can be
due to overworking or stress as the acetaminophen concentration was 38.4% when compared to the
Rumak-Matthew nomogram is it below the threshold. Therefore, no further action is needed.
Patient E could have abdominal pain and headaches prior to another health condition as the blood
plasma level taken was 27.75%. As a result, it did not reach the threshold to diagnose the patient
with overdose of paracetamol, so intervention was not required when compiled onto the Rumak-
Matthew nomogram.
Conclusion
In supposition, the lab report construed that only patient C needed intervention as patient D had
already received activated charcoal which decreased their level of acetaminophen in their blood
plasma. Furthermore, after compiling the patients concentrations onto the Rumak-Matthew
nomogram, it was evident that only patient C needed administering because the result was above
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the treatment line. The other patients could have other health related issues due to further research
methods.
References
Ba and Social Distancing, Q., 2021. Nausea and Vomiting - Common Causes. [online]
WebMD. Available at: <https://www.webmd.com/digestive-disorders/digestive-diseases-
nausea-vomiting> [Accessed 21 March 2021].
Kidshealth.org. 2021. Epilepsy (for Teens) - Nemours KidsHealth. [online] Available at:
<https://kidshealth.org/en/teens/epilepsy.html> [Accessed 21 March 2021]
Medicines.org.uk. 2021. Paracetamol 500mg Tablets - Summary of Product Characteristics
(SmPC) - (emc). [online] Available at:
<https://www.medicines.org.uk/emc/product/5164/smpc#gref> [Accessed 21 March 2021].
Graham, G., Davies, M., Day, R., Mohamudally, A. and Scott, K., 2013. The modern
pharmacology of paracetamol: therapeutic actions, mechanism of action, metabolism, toxicity
and recent pharmacological findings. Inflammopharmacology, 21(3), pp.201-232.
Drugs.com. 2021. Paracetamol: Uses, Dosage & Side Effects - Drugs.com. [online] Available
at: <https://www.drugs.com/paracetamol.html> [Accessed 21 March 2021].
nhs.uk. 2021. Paracetamol for adults: painkiller to treat aches, pains and fever. [online]
Available at: <https://www.nhs.uk/medicines/paracetamol-for-adults/> [Accessed 21 March
2021].
