ToxicologyEmergency
Paracetamol overdose
Risk stratification and N-acetylcysteine treatment for paracetamol (acetaminophen) overdose.
Source: TOXBASE/NPIS; MHRA DSU 2012/2024; SNAP regimen (Lancet 2014); BNF
Step 1 of ~11
action
Initial assessment
ABCDE; obtain accurate history:
• Time of ingestion (and pattern: single acute, staggered, therapeutic excess)
• Total dose ingested (mg/kg)
• Co-ingestants (alcohol, opioids, anticholinergics)
• Risk factors for hepatotoxicity (chronic alcohol, malnutrition, anorexia, regular enzyme inducers, HIV, low body weight)
Baseline bloods: paracetamol level (≥4 h post-ingestion), INR/PT, U&E, LFTs (ALT, ALP, bilirubin), VBG (lactate, pH, bicarbonate), glucose, salicylate level (consider).
Related
Curated clinical cross-links plus same-class fallbacks.
Drugs
- AcetylcysteineRecommendedMucolytic / Paracetamol overdose antidote
- ParacetamolRecommendedAnalgesic / Antipyretic
Same class
- Acetylcysteine (N-acetylcysteine — Paracetamol Overdose) · Mucolytic / Hepatoprotective Antidote
- Acetylcysteine (N-acetylcysteine — NAC) · Antidote — paracetamol overdose / Hepatoprotectant
- Thiamine (IV/IM — Pabrinex) · Vitamin B1 (Thiamine) — deficiency treatment / Wernicke's encephalopathy prevention
- Dextrose 10% IV · IV glucose solution (hypoglycaemia treatment)
Pathways
- TCA overdose · TOXBASE/NPIS; AACT/EAPCCT position statements; Resuscitation Council UK ALS
- Opioid overdose · TOXBASE/NPIS; Resuscitation Council UK; BNF
- Anticholinergic toxidrome · TOXBASE/NPIS; AACT/EAPCCT; BNF
- Benzodiazepine overdose · TOXBASE/NPIS; AACT/EAPCCT; BNF
- β-blocker overdose · TOXBASE/NPIS; AACT/EAPCCT; ESC; BNF
- Calcium channel blocker overdose · TOXBASE/NPIS; AACT/EAPCCT; ESC; BNF
Decision support only. Always apply local guidelines and clinical judgement.