Treatment of paracetamol toxicity is

Ans. is 'd' i.e., N - acetyl cysteine Paracetamol poisoning* It is a potent hepatic toxin. A small part is converted by a liver enzyme into N - acetyl-p-benzoquinoneimine.* Glutathione and other sulphydryl compounds detoxify this substance, but in overdose NABP accumulates and causes severe centrilobular liver necrosis.* Large doses act on brain stem and cause rapid death.Symptoms:* Within a few hours - anorexia, nausea, vomiting, abdominal pain, diaphoresis, hypotension, tachycardia and dyspnoea.* After one to two days, the discomfort disappears.* After 2 to 4 days there is vomiting, jaundice, hepatic pain, bleeding, hypoglycaemia, confusion, coma, metabolic acidosis and coarse flapping tremor of hands (asterixis).* There may be cardiac arrhythmias, haemorrhagic pancreatitis, disseminated intravascular coagulation, etc.* Death usually occurs in 3 to 4 days.Treatment:i) Gastric lavage.ii) Activated charcoal.iii) N-acetylcysteine (NAC) is a specific antidote and has maximum efficacy if used within 8 hours.