Decontamination

Following an acute ingestion of modified-release paracetamol, offer activated charcoal to alert and cooperative patients within 4 hours of ingestion.

Repeated doses of activated charcoal every 4 hours, or late administration up to 24 hours after ingestion, may be beneficial, particularly if the:

• patient ingested 30 g (or 500 mg/kg in patients under 60 kg) or more of modified-release paracetamol or an unknown dose
• serum paracetamol concentration is rising.

Seek advice from a clinical toxicologist if considering repeat or late doses of activated charcoal. Activated charcoal is not recommended in a drowsy or uncooperative patient.

If the patient is intubated, activated charcoal can be given any time after ingestion via a nasogastric or orogastric tube—confirm correct placement of the nasogastric or orogastric tube beforehand.