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Learning objectives Assessing when and how to treat a paracetamol (acetaminophen) overdose Definition Paracetamol is a mild analgesic and antipyretic medication and is safe if used in therapeutic doses Most medication overdoses, either accidentally or intentionally, are due to paracetamol overdose The most common cause of acute liver failure in the western world A dose of 150 mg/kg can cause liver damage and this threshold might be lower in people with chronic alcohol abuse or anorexia The preferred treatment is an n-acetylcysteine infusion Toxicity Management The SNAP (Scottish & Newcastle Acetylcysteine Protocol)-12 protocol is preferred over the classic 21-hour regimen for intravenous N-acetylcysteine (NAC) infusion as this has some advantages: Simple to use Fewer adverse drug reactions A shortened length of hospital stay for most patients Clinical judgment is important: Ensure that there is no doubt about the time of ingestion or the type of drug Some patients have chronically raised ALT/INR If ALT is abnormal despite a normal paracetamol concentration, consider treating for an overdose If uncertain, treat and review Suggested reading NHS Greater Glasgow and Clyde Area Drug and Therapeutics Committee

& Holton, K

Gastroenterology 101: 640649, 1991

Molecular docking, drug-likeness analysis, in silico pharmacokinetics, and toxicity studies of p-nitrophenyl hydrazones as anti-inflammatory compounds against COX-2, 5-LOX, and H+/K+ ATPase