How is paracetamol overdose treated?
Immediate management will require resuscitation and stabilisation. If the patient is unstable - such as having low blood pressure - or there is overwhelming liver failure, they will need to be treated on an intensive care unit.
The paracetamol levels will be sent off and once the result is back this is compared with a standard graph - patients who are above a certain line will need treatment. Those below the line may not require treatment. Treatment is with intravenous N-acetylcysteine (NAC) and is given to all who have high paracetamol levels.
If there is any doubt about the time of the overdose or there has been a 'staggered overdose', intravenous NAC is started without delay.
All patients will need to be seen by the psychiatric team before discharge.
NAC protects the liver and this may be the result of it restoring the glutathione levels. It may also help the liver to combat toxicity. A full treatment course consists of three consecutive bags of the medicine, mixed with intravenous fluid.
It is most effective when given within eight hours of taking the paracetamol overdose. If, however, there is ongoing damage from the paracetamol overdose then the NAC treatment may need to be prolonged. NAC is used in children and also in pregnant women. In pregnant women the paracetamol overdose can affect the liver of the fetus as well and NAC can help prevent this.
The main complication following a paracetamol overdose is liver failure. The patient may need to be referred to the specialist liver unit if the bloods confirm liver failure. Other features which will help the healthcare professionals to decide if the patient needs to go to a specialist unit include: involvement of the brain, abnormal clotting, kidney impairment, low blood pressure (hypotension), low blood sugar (hypoglycaemia) and high blood acid levels.
Urgent liver transplantation is the only treatment when overwhelming, irreversible liver failure occurs.
Further reading and references
Self harm and poisoning by sex, 2014-15; Health and Social Care Information Centre (Link to downloadable file)
Hawton K et al; Impact of different pack sizes of paracetamol in the United Kingdom and Ireland on intentional overdoses: a comparative study. Biomed central (2011)
Paracetamol overdose - revised single line treatment nomogram; Medicines and Healthcare products Regulatory Agency, Sept 2012
Ferner RE, Dear JW, Bateman DN; Management of paracetamol poisoning. BMJ. 2011 Apr 19342:d2218. doi: 10.1136/bmj.d2218.
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