Paracetamol Overdose

Question 1

Paracetamol Overdose: Management

Answer 1

• present within 1 hour - activated charcoal
  Acetylcysteine should be given if: (check others)
• staggered overdose (more than an hour) or there is doubt over the time of paracetamol ingestion

Acetylcysteine is now infused over 1 hour to reduce the number of adverse effects. Acetylcysteine commonly causes an anaphylactoid reaction (non-IgE mediated mast cell release). Anaphylactoid reactions to IV acetylcysteine are generally treated by stopping the infusion, then restarting at a slower rate.

Liver transplant:
Arterial pH < 7.3, 24 hours after ingestion
or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy