Paracetamol poisoning

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Target exams

Red flags

• Start acetylcysteine while awaiting a concentration that will not be available by eight hours
• Do not use the nomogram to decide treatment for potentially toxic modified-release ingestion
• Arterial pH below 7.30, prothrombin time above 100 seconds and creatinine above 300 micromol/L indicate a poor prognosis in acetaminophen-induced fulminant hepatic failure
• Do not stop prolonged acetylcysteine until ALT or AST is decreasing, INR is below 2.0 and the patient is clinically well, with the required concentration below 10 mg/L when applicable