Paracetamol poisoning antidote dose5/2/2023 ![]() Patients ingesting ≥ 30 g or ≥ 500 mg/kg should receive increased doses of acetylcysteine.Ĭhemical and drug induced liver injury Drug overdose Guidelines as topic Toxicology. All potentially toxic modified release paracetamol ingestions (≥ 10 g or ≥ 200 mg/kg, whichever is less) should receive a full course of acetylcysteine. Massive paracetamol overdoses that result in high paracetamol concentrations more than double the nomogram line should be managed with an increased dose of acetylcysteine. This has similar efficacy but significantly reduced adverse reactions compared with the previous three-bag regimen. ![]() The new guidelines recommend a two-bag acetylcysteine infusion regimen (200 mg/kg over 4 h, then 100 mg/kg over 16 h). Major changes in management in the guidelines: Ingestion of a licensed dose of paracetamol is not considered an overdose. ![]() Doses consistently less than 75 mg/kg in any 24-hour period are very unlikely to be toxic however risk may be increased if this dose is repeatedly ingested over 2 or more days. Cases that require different management include modified release paracetamol overdoses, large or massive overdoses, accidental liquid ingestion in children, and repeated supratherapeutic ingestions. Toxicity rarely occurs with paracetamol doses between 75150 mg/kg in any 24-hour period. ![]() The paracetamol nomogram is used to assess the need for treatment in acute immediate release paracetamol ingestions with a known time of ingestion. Patients at risk of hepatotoxicity should receive intravenous acetylcysteine. Patients who present early should be given activated charcoal. The optimal management of most patients with paracetamol overdose is usually straightforward. ![]() Main recommendations (unchanged from previous guidelines): A working group of experts in the area, with representation from all Poisons Information Centres of Australia and New Zealand, were brought together to produce an updated evidence-based guidance. Since the publication of the previous guidelines in 2015, several studies have changed practice. Paracetamol poisoning is the commonest cause of severe acute liver injury. Paracetamol is a common agent taken in deliberate self-poisoning and in accidental overdose in adults and children. ![]()
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