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Symptoms: Vomiting, hypertension, sweating, gastrointestinal haemorrhage, liver damage, cerebral oedema and renal tubular necrosis.
Treatment: Gastric emptying (unless drowsy or unconscious) and/or lavage is recommended as soon as possible after ingestion. Diazepam may be given to control central nervous system stimulation and convulsions. A beta adrenoreceptor blocking agent may be required to control cardiac arrhythmia due to phenylpropanolamine hydrochloride. Ingestion of over 140 mg/kg or 10 g (for adults) requires prompt hospital treatment.
Antidote: To prevent or reduce liver damage, oral methionine (2.5 g) should be given after emesis and/or lavage. Additional therapy (3 further doses of 2.5 g methionine at four hourly intervals or IV cysteamine) is normally considered in the light of blood paracetamol content and the time elapsed since ingestion.
