Give NAC immediately without waiting for the result of the plasma paracetamol concentration measurement if it is thought that more than 150 mg/kg body weight or a total of 12 g or more has been ingested.

Urgent action is required ( antidote efficacy drops sharply).

Mx of all patients who present 8-15 hours after ingestion. This version is provided by the MHRA and is subject to further user-testing. Please Note: The Summary of Product Characteristics should be referred to for full prescribing information. If the patient weighs less than 40kg use the paediatric dosage table.Ģ Ampoule volume has been rounded up to the nearest whole number Please circle appropriate weight and volumeġ Dose calculations are based on the weight in the middle of each band. Treatment nomogram Antidote doses ADULT NAC Adult Dosing Adult NAC prescription Staggered overdose Treat with NAC and admit to the CDU. malnutrition and HIV)ĭo NOT take plasma levels within 4 hours of ingestion as they are unreliable.īut patients may give inaccurate histories. carbamazepine, phenytoin, phenobarbitone, primidone and rifampicin)

Other enzyme (liver microsomal oxidases) inducers (e.g.

NAC is the treatment of choice when patients are vomiting or present more than 8 hours after ingestion.

Methionine is ineffective in patients who have been given oral activated charcoal.

If there is doubt about the timing or the need for treatment - treat.Acute renal tubular damage and necrosis may also occur.Those who present > 12 hours post ingestion tend to be more severely poisoned and at greater risk.Severe liver damage is defined as a peak plasma ALT exceeding 1000 u/L.At risk dose is more than 75mg paracetamol/kg body weight.Biochemical evidence of maximal damage may not be attained until 72 - 96 hours after ingestion.

Hepatocellular necrosis is the major toxic effect.For paediatric patients please use ' Paracetamol XS Paediatrics' and discuss with your EM senior. These guidelines relate to adult patients only. Background High Risk Staggered overdose NAC & methionine 24 hours post ingestion Specialist advice Adverse reactions to NAC Links

Paracetamol antidote dose