Paracetamol Overdose

Key points

• Paracetamol → NAPQI (toxic metabolite) overwhelms glutathione → centrilobular hepatic necrosis.
• Treatment: N-acetylcysteine (NAC) replenishes glutathione — most effective within 8 hours but benefit up to 24 h+.
• Use the treatment nomogram on a timed paracetamol level (≥4 h post-ingestion).
• Staggered overdose or presentation > 24 h: treat if level detectable or LFTs abnormal.
• King's College criteria guide liver transplant referral (see separate chapter).

Decision points in this pathway

• Level above treatment line (or staggered/late with abnormal LFTs)?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.