Paracetamol Poisoning - Treatment

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.

N-acetylcysteine treatment

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.

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Dr Gurvinder Rull
Peer Reviewer:
Dr Adrian Bonsall
Document ID:
29414 (v1)
Last Checked:
09 July 2017
Next Review:
08 July 2020

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.