12 The flowchart is a guideline however, and not a protocol, and individual decisions will need to be made for every patient based on their particular circumstances. It therefore augments the current NPIS paracetamol poster. It can also be used as an educational tool because it indicates the evidence (or lack of it) for each management step. The flowchart that we present will guide the clinician through the management of a patient presenting with a paracetamol overdose in a stepwise fashion. Our aim is to provide an evidence based, easy to follow, and visually attractive management guideline for paracetamol poisoning, aimed at emergency and general physicians (particularly junior doctors) dealing with this common, but often difficult to manage overdose. The guidelines have been circulated to all accident and emergency departments in the form of a poster in prose format and we support their use.

9– 11Ĭurrent guidelines for paracetamol poisoning are based on the consensus recommendations of the UK National Poisons Information Service (NPIS), they have also been adopted by the Royal College of Paediatrics and Child Health as a Good Practice Consensus Statement. 8 However, when cases stray from this simple scenario (such as with staggered overdoses, patients with high risk factors for paracetamol poisoning, or late presentation), management decisions are more complex. If the patient has taken a potentially toxic dose of paracetamol, management is guided by the plasma paracetamol concentration treatment with N-acetylcysteine in patients with a toxic plasma paracetamol concentration provides complete protection against paracetamol induced hepatotoxicity. The management of patients who present early (less than 15 hours) after ingestion of a single paracetamol overdose is straightforward. 1– 6 However, junior doctors' knowledge about the management of paracetamol poisoning is poor. Paracetamol is the commonest drug taken in overdose in the United Kingdom, accounting for 48% of all poisoning admissions to hospital and an estimated 100–200 deaths per year.

Paracetamol poisoning antidote dose