Diagnosis and treatment protocols for Paracetamol Poisoning in Uganda
Uganda Clinical Guidelines 2023 · all from source →
General Adult
Diagnosis
Clinical Features — Early (0–24 hours)
Often asymptomatic initially. Nausea, vomiting, malaise. May appear deceptively well.
Clinical Features — Late (24–72 hours)
Right upper quadrant abdominal pain. Jaundice. Liver failure (elevated transaminases, prolonged PT). Renal failure may develop.
High Risk Thresholds
Single adult dose: >150 mg/kg or >7.5 g is potentially toxic. Toxicity is enhanced in patients with hepatic disease, chronic alcohol use, malnutrition, or on enzyme-inducing drugs.
Treatment
If Presentation <2 Hours
Give activated charcoal 50 g (child: 1 g/kg) to reduce absorption. Refer urgently to hospital.
Antidote — N-Acetylcysteine (HC4)
N-Acetylcysteine (NAC) IV: Loading dose 150 mg/kg in 200 ml glucose 5% over 15 minutes. Then 50 mg/kg in 500 ml glucose 5% over 4 hours. Then 100 mg/kg in 1000 ml glucose 5% over 16 hours. Most effective if given within 8 hours; still beneficial up to 24 hours.
Monitoring
Monitor liver function tests, renal function, PT/INR, blood glucose. Refer for specialist management if liver failure develops.
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