See Detailed Steps, Procedures and Actions

See Detailed Steps, Procedures and Actions

It is strongly recommended to ring the Victorian Poisons Information Centre on 131126 regarding paracetamol poisoning management for ANY of the below:

• massive ingestions - 50 g (or 1 g/kg in patients under 50 kg) or more OR;

• double (high) dose acetylcysteine (also known as N-acetylcysteine or NAC) is required for the second bag OR;

• any uncertainty regarding management exists OR;

• high serum paracetamol concentration versus the time since ingestion (more than triple the treatment nomogram line)these patients may need very high doses of acetylcysteine OR;

• evidence of hepatotoxicity [defined as serum alanine aminotransferase (ALT) or aspartate aminotransferase (AST) of 1000 units/L or higher], coma or lactic acidosis OR;

• for immediate release paracetamol overdoses relating to intravenous paracetamol dose errors or neonatal paracetamol poisoning OR;

• for modified release paracetamol overdoses if serum paracetamol concentration is unchanged or increasing on repeat measurement OR;

• for accidental ingestion of liquid paracetamol in a less than 6 year old if serum paracetamol on or above the nomogram, if evidence of hepatotoxicity or if a neonate OR;

• for unintentional supratherapeutic dosing if evidence of hepatoxicity (see above)

 .

For the latest information regarding the management of ADULT paracetamol poisoning (including the dosage and administration of acetylcysteine) please refer to:

Including acetylcysteine prescribing:

• Austin Clinical Toxicology Guidelines and refer to Paracetamol Poisoning (noting many different sections depending on type of ingestion) and N-acetylcysteine dosing.

• Therapeutic Guidelines: Toxicology at https://tgldcdp.tg.org.au.acs.hcn.com.au and refer to Paracetamol Poisoning (noting many different sections depending on type of ingestion)

Including acetylcysteine administration:

• Australian Injectable Drugs Handbook ('yellow book').

.

Extra information regarding administration of acetylcysteine not in standard references:

• Acetylcysteine 2 g (2,000 mg) in 10 mL (200 mg/mL) ampoules must be diluted prior to use in glucose 5%. Withdraw volume of diluent from bag BEFORE adding acetylcysteine as the volume added may be large.

• See Appendix 1 - Table for confirming acetylcysteine dose and calculating volume (200 mg/mL ampoules) for adding to bag.

• Bag (dose) 1 is 200 mg/kg administered over 4 hours.

• Bag (dose) 2 is either 100 mg/kg or 200 mg/kg (high dose) depending on amount of paracetamol ingested administered; over 16 hours.

• At times for massive overdose Poisons may request triple dosing (300 mg/kg) for the second bag, or additional bags (doses) of 100 mg/kg or 200 mg/kg (high dose/double dose) administered over 16 hours after the first 2 bags.