PARACETAMOL OVERDOSE

Adapted from GlaxoSmithKline, Guidelines for the management of paracetamol overdose in Adults

ASSESSMENT

CLINICAL ASSESSMENT

Remember to question witnesses, pre-hospital providers etc. if patient is unreliable

INITIAL INVESTIGATIONS

Paracetamol level is most important investigation with selective indications for other tests

Paracetamol level (taken immediately in unknown-time ingestion or at least 4 hrs post-ingestion)

(click here to go to Rumack Diagram to interpret paracetamol level)

LFTs (if ingestion > 15 hrs ago or chronic ingestion > 150mg/kg/24hrs )

ALT > 1000 IU/L = Severe liver damage
May not rise until 72-96 hrs post ingestion

Creatinine (if ingestion > 15 hrs ago, abnormal LFTs or symptomatic)

Acute tubular necrosis (rarely)

INR (if elevated LFTs or signs of hepatic failure)

BSL (if signs of hepatic failure)

ABG  (if ingestion > 24 hrs ago, abnormal LFTs or symptomatic)

Serial paracetamol level

Indication

Method