QuestionSBA
QuestionChoice
Acetylcysteine is used in the treatment of paracetamol poisoning. However, it is used; when a plasma paracetamol concentration is within the treatment threshold, where patients present later than 8 hours and have taken over 150mg/kg of paracetamol or where patients are visibly jaundiced.
50088
c
Acetylcysteine IV
QuestionChoice
Haemodialysis is the treatment in severe salicylate poisoning. It would not be appropriate here.
50087
b
Haemodialysis
QuestionChoice
It may be appropriate to give a patient with a paracetamol overdose a resuscitation fluid bolus where they vital signs are deranged, however, the patient in this case is currently stable.
50090
e
500mL NaCl 0.9% in 10 minutes
QuestionChoice
Diazepam is used in patients who have taken an overdose of stimulant drugs or antipsychotics.
50089
d
Diazepam 10mg PO (Oral)
QuestionChoice
This patient has taken a paracetamol overdose and presented to A&E in under 1 hour, Activated charcoal should therefore be considered as the initial management of this patient.
50086
a
Activated Charcoal 50g PO (Oral)
QuestionComment
bnf poisoning treatment summary - Although the benefit of gastric decontamination is uncertain, charcoal, activated should be considered if the patient presents within 1 hour of ingesting paracetamol in excess of 150 mg/kg.
38877
QuestionComment
He has ingested 120 mg/kg, therefore he does not reach that threshold
39884
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Dominant Lumbar
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aaaaa
Concept
Chapter
#### Mechanism of Action

Paracetamol increases the pain threshold by inhibiting cyclooxygenase 1 and 2 (COX-1 and COX-2) which are involved in prostaglandin (PG) synthesis. Prostaglandins are responsible for nociception, so if prostaglandin is not synthesised, less nociception will occur. Paracetamol reduces fever by directly acting on heat-regulating centres in the brain, leading to peripheral vasodilation and sweating.

#### Indications

- Pain
- Pyrexia

#### Side Effects

- Hypotension
- Hypersensitivity reaction
- Thrombocytopenia
- Fulminant hepatic failure (in overdose)

#### Cautions/Contra-indications

Give 1g every four hours, up to a maximum of 4g in a day. Patients under 50kg are at increased risk of toxicity, so the dose must be lowered based on body weight.
582
3597
Paracetamol Overdose
Topic
9
Internal Medicine
10065
Case Presentation: A 29-year-old man is brought to A&E after taking an overdose of paracetamol 20 minutes ago. He has ingested 18 tablets (9g) of paracetamol. **PH** Depression **DH** Citalopram 40mg Oral once daily, NKDA


**On examination**
The patient looks well, not visibly jaundiced.

BP 116/86, HR90, RR 16, Temperature 36.5°C

Weight 75kg

**Investigations**

Blood to be taken 4hr after ingestion

Question: Select the most appropriate management at this stage.
a