Key changes to practice in the updated guidelines Acetylcysteine treatment It is important to check the units of measurement when using paracetamol nomograms with many laboratories recently changing from μmol/L (right axis) to mg/L (left axis).All patients with intentional self-poisoning with paracetamol should have a serum paracetamol performed, regardless of reported ingested dose.Cases that require different management include modified release paracetamol overdoses, large or massive overdoses, accidental liquid paracetamol ingestion in children and repeated supratherapeutic ingestions.The paracetamol nomogram should be used to assess the need for treatment in immediate release paracetamol ingestions with a known time of ingestion.Patients at risk of hepatotoxicity should receive intravenous (IV) acetylcysteine.Patients who present early should be given activated charcoal.The ECI have produced this page to give quick access to the important flow charts and tables used in the management of paracetamol overdose, including when and how to use NAC based on these updated guidelines.įor advice at any time about management of paracetamol ingestion contact Poisons Information Centre on 13 11 26. A Guideline Summary has also been published. Updated guidelines for the management of paracetamol poisoning in Australia and New Zealand were released in December 2019. Fortunately, N-acetylcysteine (NAC) is a safe and effective antidote which if used correctly prevents serious hepatic injury after paracetamol overdose. While paracetamol is safe in normal doses, it is hepatotoxic and potentially fatal in overdose. It is also common to see accidental paediatric ingestion, unintentional self-administered supratherapeutic ingestions or intentional self-poisoning in the Emergency Department. Paracetamol is widely used for its analgesic/anti-pyretic effects.
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