![]() ![]() The main toxicity following paracetamol poisoning is acute liver injury which results from the formation of a toxic metabolite of paracetamol, N-acetyl-p-benzoquinone imine (NAPQI). Equally do not discharge the symptomatic patient, you may have mis-timed the point of ingestion or the patient may have lied to you (about time or co-ingestants). Beyond 24 hours, symptoms should be evident (nausea, vomiting, abdominal pain or encephalopathy). Screening and testing for paracetamol in the first 24 hours is necessary as patients are asymptomatic with toxic doses. ![]() anticholinergic agents that decrease gastric emptying) and is close to the line. In these cases, start or continue NAC until the risk assessment can be refined using further biochemical parameters and paracetamol concentrations. ![]()
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