MedBugs: SAQ #611

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Case: Paracetamol Overdose

An 18-year-old female patient presents to ED following an overdose of paracetamol. The RMO reports a paracetamol concentration of 660 micromol/L (100 mg/L). The RMO would like to medically clear the patient.

1. What is the toxic dose of paracetamol in an adult following an acute ingestion? 1 mark

2. List 2 questions you need to ask on history to interpret the result and need for treatment. 2 marks

3. State 2 ways the paracetamol treatment nomogram can be utilised in paracetamol toxicity. 2 marks

The RMO has assessed the patient and has “medically cleared” them and they have been transferred to psychiatry. The psychiatric registrar calls you and is concerned that the patient should have antidote treatment for paracetamol poisoning. She tells you the patient ingested 40 x 500mg paracetamol staggered between 2 am and 6 am. The paracetamol level was taken at 10 am. It is now 4pm.

4. What is your ongoing management for the staggered paracetamol ingestion that was initially medically cleared? 4 marks

A 27-year-old male ingested 50 x 665mg (33.250g) of Panadol Osteo 3 hours ago.

5. State important aspects of management of a large modified-release paracetamol overdose, including doses. 2 marks

An adult patient arrives 7 hours after ingesting 12g of Paracetamol IR

6. What is the most important aspect in the initial management of an adult arriving 7 hours after ingesting 12 g of immediate-release paracetamol? 1 mark

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