Acetaminophen (Paracetamol) Poisoning, fatal dose and Management.

Acetaminophen is an over the counter drug, easily available without a prescription, but if taken especially if more than 12g is taken which is potentially fatal. The cause of death or the complication is usually the liver failure, which likely occurs if more than 250mg/kg of paracetamol is taken.

If a patient arrives at the emergency department with paracetamol poisoning and has taken more than 200mg/kg or more than 10g of paracetamol then immediately resuscitate and start acetylcysteine which is the antidote for paracetamol poisoning.

The dose of Acetylcysteine and Method of Administration

Consider Oral acetylcysteine, if the patient is not confused and can easily tolerate the medicine orally, the injectable acetylcysteine may also be given by oral route.
The oral dose is as follows.

Oral Administration of Acetylcysteine

The loading dose is 140mg/kg, after giving the loading dose, wait for four hours and after four hours give the maintenance dose, which is 70mg/kg. Repeat the maintenance dose after every 4 hours and give total seventeen doses, one dose after every four hours (total seventeen doses)
If the patient vomits within one hour of oral administration, repeat the dose.

Intravenous Administration of Acetylcysteine

If a patient is unable to tolerate the oral dose due to repeated vomiting or confusion then give acetylcysteine intravenously according to the following directions;
1. Give loading dose, which is 150mg/kg, mix it with 200ml of dextrose water 5%, and infuse is over the period of one hour.
2. After the loading dose, give 50mg/kg, mixed with 500ml of dextrose 5% and transfuse it over the period of 4 hours,
3. after this add 100mg/kg of acetylcysteine to 1000ml of dextrose 5% and infuse it over the period of sixteen hours.

Monitor vital signs, liver and renal function test, mental status, and urine output.