EM · Paracetamol poisoning

Paracetamol poisoning

Also known as Acetaminophen poisoning · Acetaminophen overdose · Paracetamol overdose · NAPQI hepatotoxicity

Paracetamol (acetaminophen) overdose — the commonest cause of acute liver failure in the developed world, and a self-poisoning that is silent in the first 24 hours. The mechanism (the CYP2E1 oxidation to NAPQI, the glutathione depletion, the zone-3 centrilobular necrosis), the time-critical Rumack-Matthew nomogram (the paracetamol level drawn at 4 hours post-ingestion), the antidote (N-acetylcysteine — 150 mg/kg over 1 hour, then 50 mg/kg over 4 hours, then 100 mg/kg over 16 hours, 300 mg/kg over 21 hours), the indications (any level above the treatment line, unknown time with a detectable level, the staggered overdose, the late presentation with hepatic injury), the King's College criteria for transplantation, and the principles of treating the established acute liver failure. ACEM-primary, globally tagged.