Right upper quadrant tenderness may begin to develop subsequently.Occasionally they complain of nausea, vomiting, pallor and diaphoresis.Most patients who present within 24 hours of ingestion are asymptomatic.If possible, determine the exact name and tablet sizeĬalculate the maximum possible dose per kgĬonsider the possibility of co-ingestions, either accidental or deliberate Examination Any child whose developmental age is inconsistent with accidental poisoning as non-accidental poisoning should be consideredįorm: syrup, immediate or modified-release tablets.All children with deliberate self-poisoning.Repeated supratherapeutic ingestion of >100 mg/kg/day.Hepatic failure and death are uncommon outcomes, but paracetamol remains the most important single cause of acute fulminant hepatic failure in Western countries.It is involved in a large proportion of accidental paediatric exposures and deliberate self-poisonings and is the leading pharmaceutical agent prompting calls to poisons information centres across Australia and New Zealand.Paracetamol is the most widely used over-the-counter analgesic in the world.Complicated overdoses involving longer-acting forms of paracetamol (eg Panadol Osteo) or staggered ingestions should be discussed with a toxicologistįor 24 hour advice, contact the Poisons Information Centre 13 11 26 Background.Stated timing and dose of paracetamol ingestion are often unreliable and this needs to be taken into consideration.Time to NAC is crucial in protecting the liver from significant toxicity N-acetylcystine (NAC) is a safe and effective antidote.

Suspect paracetamol poisoning in all deliberate adolescent self-poisonings.

Poisoning – acute guidelines for initial management Resuscitation Key points

Acetaminophen antidote