MyCpdZw - Protocols Details

PARACETAMOL POISONING

Paracetamol poisoning, also known as acetaminophen poisoning, is caused by excessive use of the medication paracetamol (acetaminophen). Most people have few or non-specific symptoms in the first 24 hours following overdose. This may include feeling tired, abdominal pain, or nausea.

Diagnosis

Adult toxicity likely after consumption of 10-15 g.

Very few early features of toxicity but may have nausea, vomiting, shock, confusion or hepatic or renal failure.

Prothrombin Time (PT) is a good early indicator of toxicity.

Peak in aminotransferase (ALT)> 1000 U/L defines extent of damage.

Checking Paracetamol blood levels prior to 4-hours after ingestion is futile & unreliable.

Management

1. ABC’s & Resuscitation as indicated,

2. IV access,

3. FBC, U&E’s, LFT’s, Coagulation profile as indicated

4. Paracetamol levels if >4 & <15-hours since ingestion,

5. If time of ingestion is unknown do Paracetamol level & repeat after 2-4 hours. If slope is flatter than nomogram treatment line then treat with NAC,

6. If a sustained release formula of Paracetamol has been taken obtain a second Paracetamol 4 hours after the initial one.

7. Charcoal 50g if time since ingestion <1 hour & 200 mg/kg ingested (NOT INDICATED IN CHILDREN),

8. Start N-AcetylCysteine (NAC) if:

· Presents with significant overdose (>10g) until levels are perfomed,

· Symptoms at initial presentation- until definitive levels return or

· Above treatment line on nomogram (even up to 15 hours after ingestion).

· Beware- NAC Stinks!!!

9. Give Vitamin K if INR raised,

10. If presentation is >15 hours after ingestion the nomogram is useless & treatment should be given if >10 g (or 150 mg/kg) has been ingested. Treatment may be stopped only if asymptomatic, normal LFT’s & Paracetamol levels are <70 (10MG/l),

11. If presentation is >24 hours after ingestion it is probably worth trying NAC if significant overdose has been taken.

Children <20 kgs:

· 150 mg/kg in 3 mLs/kg over 15 minutes,

· Then 50 mg/kg in 7 mLs over 4, 8 & then 8 hours.

Children >20 kg:

· 150 mg/kg in 100 mLs over 15 minutes,

· Then 50 mg/kg in 250 mLs over 4, 8 & then 8 hours.

Acetylcysteine is supplied as Parvolex 2g/10ml (200mg/ml).

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