Source: Thailand Medical News Dec 03, 2019 5 years, 11 months, 2 days, 21 hours, 31 minutes ago
Emerging evidence has prompted a change in the management of
paracetamol poisoning, according the authors of the updated guideline summary published online today by the
Medical Journal of Australia.
Past guidelines were published by the MJA in 2015 but further research has emerged, particularly regarding acetylcysteine regimens, massive paracetamol ingestions, and modified release
paracetamol ingestion.
The research authors, led by Dr. Angela Chiew, an emergency physician and toxicologist at the Prince of Wales Hospital and a clinical toxicologist at the NSW Poisons Information Centre, made three adjusted recommendations to reflect that evidence.
Firstly, the new guidelines recommend a two-bag acetylcysteine infusion regimen (200 mg/kg over 4 hours, then 100 mg/kg over 16 hour); this has similar efficacy but significantly reduced adverse reactions compared with the previous three-bag regimen.
Secondly, in cases of massive
paracetamol overdoses that result in high
paracetamol concentrations more than double the
paracetamol nomogram line should be managed with an increased dose of acetylcysteine.
Thirdly, all potentially toxic modified release
paracetamol ingestions (≥ 10 g or ≥ 200 mg/kg, whichever is less) should receive a full course of acetylcysteine. Patients ingesting ≥ 30 g or ≥ 500 mg/kg should receive increased doses of acetylcysteine.
Furthermore, Chiew et al included a management flow chart for rural and remote centres with limited pathology facilities.
Dr. Angela Chiew told
Thailand Medical News via a phone interview, "Many rural and remote health care facilities do not have access to 24-hour pathology or have very limited pathology services (eg, point of care testing only).These facilities can still manage certain acute
paracetamol poisoning cases, provided acetylcysteine is available and the patient is not at high risk of developing acute liver injury. We have outlined the management of acute immediate release
paracetamol ingestion for rural and remote facilities and the criteria for determining when transfer is required."
For more details, refer to the link below for the full published guidelines.
Reference : Medical Journal of Australia (2019). DOI: 10.5694/mja2.50428
