Paracetamol overdose in adults

Follow your local protocols for recommended monitoring for liver toxicity throughout and after the acetylcysteine infusion. Parameters (and the recommended intervals to monitor) vary according to the regimen used; these may include:

• International normalised ratio (INR)

• Urea and electrolytes

• Alanine aminotransferase (ALT).

Test results indicate liver toxicity if:[3]National Poisons Information Service. TOXBASE. Paracetamol. 2023 [internet publication]. https://www.toxbase.org

• ALT has doubled (or more) since the admission measurement

  OR

• ALT ≥2 times the upper limit of normal

  OR

• INR >1.3 (in the absence of another cause, e.g., warfarin).

If there is evidence of liver toxicity:

• Continue acetylcysteine[3]National Poisons Information Service. TOXBASE. Paracetamol. 2023 [internet publication]. https://www.toxbase.org

• Follow local protocols, as recommended actions vary according to the acetylcysteine regimen used.

If you are uncertain, discuss individual patients with your local poisons information service (in the UK, the National Poisons Information Service [NPIS]). National Poisons Information Service: TOXBASE Opens in new window

• Stop acetylcysteine infusion if:[3]National Poisons Information Service. TOXBASE. Paracetamol. 2023 [internet publication]. https://www.toxbase.org

  • The INR is ≤1.3

    OR

  • The INR is falling towards normal on two consecutive blood tests, AND is <3.0.

If there is no evidence of liver toxicity, stop acetylcysteine and consider discharge.[3]National Poisons Information Service. TOXBASE. Paracetamol. 2023 [internet publication]. https://www.toxbase.org