Paracetamol posioning?

End

Start AC if >75 mg/kg taken: stop AC if plasma paracetamol level is below treatment line (Fig. 36.3)

If < 1 h since ingestion and >75 mg/kg taken, give activated charcoal 50g PO

Give AC course if >150 mg/kg taken, or there are clinical features of liver damage^*, or abnormal results

(0–8 h)

Give AC course if plasma paracetamol level is above treatment line (Fig.36.3)
If level is not available by 8 h after ingestion, and >75 mg/kg taken, start AC: stop if level is below treatment line

Discuss with Liver Unit
See Chapter 77 for management of acute liver failure

Medically fit for discharge
Psychiatric assessment

Check plasma paracetamol level, prothrombin time, ALT/AST, bilirubin, phosphate, creatinine, acid–base status (venous sample) and FBC

(0–24 h)

(>24 h)

Time since ingestion?

0–8 h

0–24 h

>24 h or staggered poisoning

^* Nausea and vomiting >24 h after ingestion, right subcostal pain and tenderness

On completion of AC course, reassess clinical status and check/recheck blood tests above

Clinical features of liver damage^*, or abnormal blood results

No clinical features of liver damage^*, normal blood results