- In cases where the actual tme of ingestion of paratamol is known Rumack-Matthew nomogram is used. If the plasma paracetamol concentration is above the curve/line the probability of hepatotoxicity is high and N-acetylcysteine should be considered.
- The criteria used in determination of patients requiring treatment include: acute ingestion of more than 200mg/kg, total daily dose of more than 100mg/kg/day and when the quantity ingested is unknown
- or gastric lavage if within 4 hours of ingestion
- Activated charcoal preferably not within 1 hr of administration of the antidote
- N-acetylcysteine; 200mg/mL, 10mL]
*Total dose = 300mg/kg: 150 mg/kg over the first hr, 50 mg/kg over the next 4 hrs 100mg/kg over the next 16 hours.
*It can be diluted in 5% dextrose or normal saline.
*Monitor paracetamol plasma concentration and if it is more than 120 µmol/L continue the infusion.
- After 5 days of poisoning hepatotoxicity has either resolved or it is worse.