Paracetamol overdose in adults

Before discharge, give the patient verbal and written advice to:[3]National Poisons Information Service. TOXBASE. Paracetamol. 2023 [internet publication]. https://www.toxbase.org

• Return to hospital if they develop vomiting, abdominal pain, or jaundice

• Seek medical attention if they develop symptoms of adverse reaction to acetylcysteine:

  • Nausea, vomiting, flushing, urticarial rash, angioedema, tachycardia, and bronchospasm are relatively common

  • Hypotension and collapse are uncommon

• Avoid paracetamol:

  • For the next 2 weeks if they have ongoing abnormal liver function but meet the criteria for stopping acetylcysteine

  • For the next 12 hours if they did not meet the criteria for acetylcysteine treatment but had an initial serum paracetamol concentration >20 mg/L.

Always seek advice from a senior colleague or the appropriate mental health team before discharging a patient if they have taken an overdose with the intention of self-harm or suicide. See Suicide risk management.

Advise all patients to seek medical attention if symptoms of an acetylcysteine-related anaphylactoid reaction develop after discharge.[3]National Poisons Information Service. TOXBASE. Paracetamol. 2023 [internet publication]. https://www.toxbase.org See Complications.