Paracetamol Poisoning

exp date isn't null, but text field is

  • Paracetamol is an ingredient of many over the counter pain, cold, and flu remedies
  • A dose of over 150 mg/kg (i.e. approx. 10 g in an adult) may cause severe liver and (less frequently) kidney damage within hours of ingestion
  • In the first 24 hours there may be nausea and vomiting or there may be no sign of poisoning
  • Persistence of these symptoms and associated right subcostal pain and tenderness usually indicates hepatic necrosis
  • Liver damage reaches a maximum 3-4 days after poisoning and may be fatal

Even if there are no significant early symptoms, overdose patients should be urgently transferred to hospital

If overdose occurs within 4 hours of admission:

  • Empty the stomach to remove ingested medicine
  • If respiration is depressed: do not use emesis - use airway protected gastric lavage instead
  • Keep patient warm and quiet
  • Observe carefully for at least 3-4 days
  • Monitor fluid, electrolytes, blood glucose, liver and kidney function
  • Give supportive care and correct fluid and electrolyte balance as required

Adults:

If within 24 hours of overdose with over 10g of paracetamol:

  • Give the specific antidote N-acetylcysteine as an IV infusion in Glucose 5%
  • Initially give 150mg/kg in 200ml over 15 minutes
  • Then give 50 mg/kg in 500 ml over 4 hours
  • Then give 100mg/kg in 1L over 16 hours

If a serious reaction occurs:

  • Stop the infusion
  • Treat the reaction
  • Restart the infusion

Children:

Treatment is usually guided by Paracetamol levels

If these are unavailable, use the empiric Acetylcysteine regimen

Weight

Initial Dose

Second Dose

Third Dose

Instructions

<20 kg

150 mg/kg in 3 ml/kg fluid over 1 hour

50 mg/kg in 7 ml/kg over 4 hours

100 mg/kg in 14 ml/kg over 16 hours

Mix in 5% Dextrose or 0.9% sodium chloride

20-40 kg

150 mg/kg in  100 ml fluid over 1 hour

50 mg/kg in  250 ml over 4 hours

100 ml/kg in  500 ml over 16 hours

Mix in 5% Dextrose or 0.9% sodium chloride

>40 kg

150 mg/kg in  200 ml fluid over 1 hour

50 mg/kg in  500 ml over 4 hours

100 ml/kg in 1 litre over 16 hours

Mix in 5% Dextrose or 0.9% sodium chloride

Anaphylaxis to Acetylcysteine should be managed in accordance with standard treatment protocols, but the infusion should be continued at a slower rate. 

If Acetylcysteine is not available, then PO Methionine can be used:

       •      < 20 kg      

625 mg 

       •      20 – 40 kg

1.25grams 

       •      >40 kg       

2.5grams