Lightning Learning: Paracetamol Overdose

Lightning Learning: Paracetamol Overdose

Here’s a quick guide for identifying the signs of paracetamol overdose and what to do in the Emergency Department.
— advice is based on local guidelines & procedures


Paracetamol is the most common drug to be taken in overdose (48% of poisoning related admissions). It can be fatal if not treated appropriately (between 100-200 deaths per year).

Paracetamol-induced hepatic injury is most likely to occur after ingestions of >10g or >200mg/kg. Ingestion of ≥75mg/kg is considered a significant ingestion and needs further investigation.


Do bloods immediately unless ingestion <4 hours ago then delay bloods until 4 hours post-ingestion.

Start NAC immediately, if…

  • Single ingestion >15 hours ago

  • Staggered ingestion

  • Timing of overdose uncertain

  • Ingestion >4 hours ago and bloods results will not be known within 8 hours of ingestion

Give activated charcoal, if…

  • Ingestion <1 hour ago AND dose >150mg/kg

Wait for blood results before prescribing NAC, if…

  • Ingestion >4 hours ago and blood results will be known with 8 hours of ingestion

Lightning Learning: Orthostatic Hypotension

Lightning Learning: Orthostatic Hypotension

Lightning Learning: Spontaneous Pneumothorax

Lightning Learning: Spontaneous Pneumothorax