When to call a poisons information centre for modified-release paracetamol poisoning

When treating a patient for modified-release paracetamol poisoning, seek advice from a poisons information centre (13 11 26) for:

  • massive ingestions—50 g (or 1 g/kg in patients under 50 kg) or more of modified-release paracetamol
  • high serum paracetamol concentration versus the time since ingestion (more than triple the treatment nomogram line)—these patients may need very high doses of acetylcysteine
  • serum paracetamol concentration is unchanged or increasing on repeat measurement
  • evidence of hepatotoxicity1; coma or lactic acidosis.
1 Hepatotoxicity is defined as serum alanine aminotransferase (ALT) concentration (or aspartate aminotransferase [AST]) of 1000 U/L or higher.Return