Paracetamol Poisoning

The management of Paracetamol poisoning depends upon the quantity of Paracetamol ingested and the time since ingestion.

Always refer to ToxBase when managing poisoned patients.

Within 1 hour of overdose

Activated charcoal can be given as decontamination (absorption from the gut is usually complete within two hours).

If the quantity is potentially life threatening, gastric lavage is thought to be useful. Contraindications to lavage are patients who have a compromised, unprotected airway.

Within 8 hours of overdose

N-Acetyl Cysteine is proven to reduce the risk of serious hepatotoxicity.

Indications for consideration of liver transplant:

• Acidaemia (pH <7.3)
• Renal insufficiency
• Hepatic encephalopathy
• Elevated PT

The King’s College Criteria:

pH < 7.3

or

In a 24h period, all 3 of:

• INR > 6 (PT > 100s) +
• Cr > 300mmol/L +
• grade III or IV encephalopathy