Poisoning with acetaminophen (paracetamol)

Abstract

Paracetamol is the most widely used over-the-counter analgesic agent in the world. It is involved in a large proportion of accidental paediatric exposures and deliberate self-poisonings. Hepatic failure and death are uncommon outcomes, although paracetamol remains the most important single cause of acute fulminant hepatic failure in Western countries. Following patients require assessment: a) acute ingestion of >200mg/kg; b) ingestion of unknown quantity and c) repeated supratherapeutic ingestion of >100mg/kg/day. 

The optimal management of most patients with paracetamol overdose is usually straightforward. However, several differing nomograms and varying recommendations regarding potential risk factors for hepatic injury introduce complexity.

In order to reconcile management advice with current clinical toxicology practice, these new guidelines by Society of Azeri Toxicologists have been developed by a panel of clinical toxicologists consulting to the poisons information centres using a workshop and consultative process.