The management of paracetamol poisoning

Paracetamol poisoning is a common presentation in paediatrics. Toxicity may cause hepatocellular injury, in certain cases progressing to fulminant liver failure. Young children appear less at risk of hepatotoxicity due to an increased metabolic capacity for paracetamol. A single dose of 150 mg/kg can cause hepatocellular damage. Children who ingest multiple supratherapeutic doses can accumulate significant concentrations and may suffer worse outcomes. Older children who intentionally overdose may also suffer worse outcomes, especially those who present late. The risk of hepatotoxicity after a single overdose can be predicted using a widely used nomogram, although it was derived from adult data. The cornerstone of management is administering the antidote N-acetylcysteine when hepatotoxicity is likely to occur. The National Poisons Information Service is available to be consulted at all hours. When severe poisoning is suspected, the child may require referral to a liver unit in view of possible liver transplantation.