Clinical presentation

Effects of immediate-release paracetamol poisoning include:

• gastrointestinal effects—nausea, anorexia, persistent vomiting, right upper quadrant abdominal pain
• kidney impairment—can occur in severe liver failure, or occasionally as an isolated event
• mild coagulopathy—the international normalised ratio (INR) may be slightly raised (INR no higher than 2.0) at an early stage, due to paracetamol directly inhibiting clotting factor production
• liver failure—a late complication; causes hypoglycaemia, metabolic acidosis, severe coagulopathy and hepatic encephalopathy.

Massive doses of immediate-release paracetamol (more than 50 g [or 1 g/kg in patients under 50 kg]) can cause an altered conscious state (ranging from drowsiness to coma) and lactic acidosis.