New paracetamol OD treatment graph and dose for NAC

Submitted by Alice Byram

The College of Emergency Medicine Quality in Emergency Care Committee (QEC) has worked closely with the Medicines & Healthcare Products Regulatory Agency (MHRA) to update guidance following a review by the Commission on Human Medicines of the treatment of paracetamol poisoning.

The key changes from previous guidance are:
•A single treatment line regardless of hepatotoxicity risk (see Annex I, below).
•The duration of administration of the first dose of intravenous acetylcysteine is increased from 15 minutes to 1 hour.
•Removal of hypersensitivity as a contraindication to treatment with acetylcysteine.
•Provision of weight-based dosing tables for adults and children.
•A Technical Information Leaflet (TIL) which gives more detailed instructions on the preparation of acetylcysteine infusions

Further information and document downloads are available  here

Please see below for treatment line nomogram and dosage charts (you will need to scroll down the page to see the charts).

Revised paracetamol overdose treatment nomogram:

Paracetamol OD treatment line























adult acetylcysteine prescription



























paediatric acetylcysteine dose table





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