Paracetamol OD

Rumack Mathew Normogram

Only suitable if 

  • time of ingestion is known
  • no repeated ingestions

Indications for Acetylcystein

  • Serum level above the “possible hepatic toxicity” line of the Rumack-Matthew nomogram 
  • Serum level unavailable within 8 hours post ingestion and Paracetamol ingestion suspected 
  • Time of ingestion is unknown and serum level is greater than 10 micrograms/ml 
  • Evidence of ANY hepatotoxicity with a history of Paracetamol ingestion 
  • Patient reports or clinician suspects repeated excessive Paracetamol ingestions
  • Patient has risk factors for hepatotoxicity, and the serum level is greater than 10 mcg/ml 

 Dosage i.v.

300mg/kg over 20h

  • bolus 150mg/kg over 15min
    • then 50mg/kg over 4hrs
    • then 100mg/kg over 16 hrs

Side effects

Anaphylaxis, rash, angioedema

Vomiting and flushing