Poisoning

Question 1

Patients requiring management after paracetamol poisoning

Answer 1

Acute ingestion of over 200mg/kg
Ingestion of unknown quantity
Repeated supratherapeutic ingestion of over 100mg/kg/day

Question 2

Management of paracetamol poisoning (acute ingestion)

Answer 2

If presents less than 4h post ingestion:
- take paracetamol level at 4h, plot on nomogram and treat if indicated
If present 4-8h:
- take paracetamol level immediately
- plot on nomogram, treat if indicated
If present over 8h post ingestion:
- Commence NAC immediately
- paracetamol level and ALT immediately
- Plot on nomogram, discontinue NAC if indicated + ALT normal
- seek help if ALT raised with paracetamol level below line

Question 3

Dosing of NAC (n-acetyl cysteine) in paracetamol poisoning

Answer 3

3 stage infusion giving total dose of 300mg/kg

• 150mg/kg over first hour
• 50mg/kg over next 4 hours
• 100mg/kg over next 16 hours

In adults/adolescents, dilute in 250, 500, 1000mL bags respectively
In children: each in 250mL bags (smaller in infants)
Normal saline or dextrose