![]() For this group a weight of 110kg should be used to calculate their toxic dose (mg/kg) and their drug dose. Low weight - patients 110kg can be treated using this protocol.Use the NHSGGC Acetylcysteine Prescribing and Administration Chart which is located in all Emergency Departments and Medical Receiving areas. ![]() Therapeutic excess paracetamol overdose (ingested total overdose in >1 hour time period no self-harm intent).Staggered overdoses (ingested total overdose in >1 hour time period in the context of self-harm).≥75mg/kg of paracetamol over a period of 24 hours (ingested total overdose in ≤1 hour time period).Patients who have ingested (any of the following):.Therapeutic excess (any of the following):.Self-harm - all patients (irrespective of reported ingested dose or timing, clinical judgement required if historical).Patient should undergo a further hospital medical assessment if: ![]() The standard local protocol is acetylcysteine IV in two infusions with the option to extending depending on biochemical criteria. In some scenarios the paracetamol level can be plotted against a single treatment line on the paracetamol treatment nomogram. Management of a patient suffering from a paracetamol overdose is dependent on the presentation scenario and time from ingestion. It may also be effective up to and possibly beyond 24 hours. It has near 100% efficacy in preventing paracetamol-induced hepatotoxicity if given within the first 8 hours from ingestion of overdose. ![]() A cetylcysteine IV (N-acetylcysteine, Parvolex ®, NAC) is the treatment of choice. In overdose the potential risk of a patient having significant liver damage is directly proportional to the amount of paracetamol ingested. TOXBASE (password required) should continue to be used as a clinical decision support resource in conjunction with the National Poisons Information Service (NPIS, 03). While the MHRA has not yet approved its use, TOXBASE now lists the regime as a recognised treatment period. The same dose of N-acetylcysteine is administered in this regime but over a 12-hour ( not 21-hour) treatment period. This guideline reflects the local NHSGGC policy on acetylcysteine use in adult paracetamol overdoses and is based on the Scottish and Newcastle Anti-emetic Pre-treatment for Paracetamol Poisoning (SNAP) regime. ![]()
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