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120 mg/5 mL: Overdose and treatment: Symptoms include hepatic necrosis, transient azotemia, renal tubular necrosis with acute toxicity, anemia, and GI disturbances with chronic toxicity. Acetylcysteine 140 mg/kg orally (loading) followed by 70 mg/kg every 4 hours for 17 doses. Therapy should be initiated based upon laboratory analysis suggesting high probability of hepatotoxic potential. Activated charcoal is very effective at binding acetaminophen.
250 mg/5 mL: Symptoms: Paracetamol toxicity may result from a single toxic dose, from repeated ingestion of large doses of paracetamol (e.g. 7.5-10 g daily for 1-2 days), or from chronic ingestion of the drug.
Nausea, vomiting, and abdominal pain usually occur within 2-3 hours after ingestion of toxic doses of the drug. Fulminant, fatal hepatic failure may occur in chronic alcoholics following overdosage of paracetamol. P-Aminophenol derivatives may elevate serum bilirubin concentrations, and jaundice may develop within 2-6 days. Young children appear to be less likely to develop hepatotoxic effects than adults.
Treatment: If paracetamol has been recently ingested, activated charcoal may reduce paracetamol absorption and should be administered as soon as possible (preferably within 1 hour of ingestion). Acetylcysteine therapy is initiated within 8-16 hours of ingestion, but acetylcysteine is effective when given more than 24 hours after ingestion.
Acetylcysteine 20% i.v.: Administer intravenously, 20% acetylcysteine immediately without waiting for positive urine test or plasma level results: initial dose of 150 mg/kg over 15 minutes, followed by continuous infusion of 50 mg/kg in 500 ml 5% glucose/dextrose over 4 hours and 100mg/kg in 1 L 5% glucose/dextrose over 16 hours; or.
Oral Methionine: 2.5 g immediately followed by three further doses of 2.5 g at four hourly intervals. For a 3-year-old child, 1 g methionine every four hours for four doses has been used; or.
Oral Acetylcysteine 5%: 140 mg/kg as a loading dose, then 70 mg/kg every 4 hours for a total of 17 maintenance doses. If more than ten hours have elapsed since the overdosage was taken, the antidote may be ineffective.
