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Paracetamol poisoning



Paracetamol (N-acetyl-p-aminophenol) is a common antipyretic and analgesic, that is used worldwide. It is the commonest taken drug overdose.

Risk Factors

Signs and symptoms

Diagnostic criteria

Phase-1: 0.5–24 hours after ingestion:

Asymptomatic to nonspecific symptoms
• Anorexia
• Nausea
• Vomiting
• Malaise
• Pallor
• Diaphoresis

Phase-2: 18–72 hours after ingestion:

• Right upper quadrant abdominal pain
• Anorexia
• Nausea
• Vomiting
• Tender right upper quadrant
• Tachycardia
• Hypotension
• Oliguria

Phase-3: 72–96 hours after ingestion:

All of the above
• Jaundice
• Coagulopathy
• Hypoglycemia
• Hepatic encephalopathy
• Acute renal failure

Phase-4: 4th day to 3weeks after ingestion:

• Patient who survive critical illness in phase 3, have complete recovery.


• Liver Function Test- ALT, AST, ALP, PT with INR (International Normalization Ratio)
• Glucose
• Renal Function Test: Electrolytes, BUN, creatinine
• ABG-Arterial Blood Gas


  • Non-pharmacological

    • Rescucitation
    • Usually there is no immediate threat to the airway, breathing and circulation with paracetamol poisoning
    • Correct hypoglycaemia (Give glucose or sugar or honey)
    • If within 1 hour of ingestion of 150mg/kg or more paracetamol give activated charcoal, if available, or induce vomiting.
  • Pharmacological

    • Activated charcoal (1gm/kg, up to 50gm) if less than 2 hours.

    If more than 8 hours after ingestion, or the patient cannot take oral treatment, give:

    o Acetylcystein 150mg/kg IV in 200mls of 5% Dextrose over 20 minutes, then 50mg/kg in in 500mls of 5% dextrose over 4 hours, then 100mg/kg in 1 liter of 5% dextrose over 16 hours.
    o In severe poisoning a further 100mg/kg may be given over the next 24 hours Children <20kg: Give loading dose of 150mg/kg in 3ml/kg of 5% glucose, over 15 minutes, followed by 50 mg/kg in 7 ml/kg of 5% glucose over 4 hours, then 100 mg/kg IV in 14 ml/kg of 5% glucose over 16 hours.

    For conscious and not vomiting or when there is severe reaction to Nacetylcysteine give:

    • Methionine (<6 years: 1 gram every 4 hours - 4 doses; 6 years and above: 2.5 grams every 4 hours for 4 doses).


Educate the patient on Dos and Don’ts of poisoning prevention.


• Keep medicines and poison in proper containers and out of reach of children
• Use containers with child resistant caps
• Keep all products in their original container
• Read medicine labels carefully to avoid mistake


• Leave container open
• Transfer products from their origin
• Remove labels from the medicine products
• Put tablets into another containers such as purse or envelope
• Medicine/tablets as sweet
• Take your medicine in front of children as they often copy

Updated on,

14 Novemba 2020 15:02:00


    1. STG
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