Paracetamol Overdose

Question 1

Paracetamol overdose: management

Management

The following is based on 2012 Commission on Human Medicines (CHM) review of paracetamol overdose management.

Answer 1

Acetylcysteine should be given if:

• there is a staggered overdose* or there is doubt over the time of paracetamol ingestion, regardless of the plasma paracetamol concentration; or
• the plasma paracetamol concentration is on or above a single treatment line joining points of 100 mg/L at 4 hours and 15 mg/L at 15 hours, regardless of risk factors of hepatotoxicity

Question 2

Paracetamol overdose

King’s College Hospital criteria for liver transplantation (paracetamol liver failure)

Answer 2

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