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Emergency Acute Paracetamol Intoxication

Risk stratification and antidote management of paracetamol overdose.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Acil Servis department. Book Appointment →

What is Emergency Acute Paracetamol Intoxication?

Acute paracetamol intoxication is the most common drug overdose causing acute liver failure. Adult hepatotoxic dose is 150-200 mg/kg; chronic alcohol users, those on enzyme-inducing drugs and those with liver disease are hepatotoxic at lower doses.

Toxicity is mediated by NAPQI, the toxic metabolite produced via the CYP2E1 pathway, which depletes glutathione and produces hepatocellular necrosis. Centrilobular necrosis develops 24-48 hours after ingestion.

Risk stratification is performed with the Rumack-Matthew nomogram on the serum paracetamol level at 4 hours after ingestion; treatment is indicated if above the toxic line. N-acetylcysteine is the antidote and is most effective when started within 8 hours.

Symptoms

Initial 24 hours: nausea, vomiting and malaise
24-72 hours: right upper quadrant pain and ALT elevation
72-96 hours: hepatotoxicity peak, jaundice and coagulopathy
Encephalopathy and acute liver failure (severe)
Acute kidney injury
Lactic acidosis
Hypoglycaemia

Risk Factors

Suicide attempt
Accidental overdose (multiple paracetamol-containing products)
Chronic alcohol consumption
Pre-existing liver disease
Enzyme inducer drugs (phenytoin, carbamazepine, isoniazid)
Malnutrition and fasting
Pregnancy

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Suspected paracetamol intoxication or known overdose
  • Persistent vomiting and right upper quadrant pain
  • Findings of jaundice and hepatic failure
  • Findings of encephalopathy or coagulopathy

Treatment Methods

01
Activated charcoal within 1 hour after ingestion
02
Serum paracetamol level at 4 hours
03
Risk classification with Rumack-Matthew nomogram
04
N-acetylcysteine 21-hour intravenous protocol
05
Maintain serum glucose and correct electrolytes
06
Liver transplantation according to King's College criteria
07
Multidisciplinary follow-up in toxicology and intensive care

Which Department to Visit?

You can visit our Acil Servis department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Let us help you

You can make an appointment with our specialists or contact us for your concerns.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.