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Comparative Study
. 2008 Sep;53(3):89-92.
doi: 10.4038/cmj.v53i3.248.

Management of acute paracetamol poisoning in a tertiary care hospital

S M D K G Senarathna  1 , S Sri Ranganathan, A H Dawson, N Buckley, B M R Fernandopulle
Affiliations
Comparative Study

Management of acute paracetamol poisoning in a tertiary care hospital

S M D K G Senarathna et al. Ceylon Med J. 2008 Sep.

Abstract

Objectives: To compare the management of acute paracetamol poisoning with the best evidence available, and to determine the effect of plasma paracetamol level estimation on the management.

Design: Descriptive study with an intervention.

Setting: Medical wards of the National Hospital of Sri Lanka, Colombo.

Patients: Patients admitted with a history of acute paracetamol poisoning.

Intervention: Measurement of plasma paracetamol.

Methods: Data were obtained from the patients, medical staff and medical records. Plasma paracetamol was estimated between 4-24 hours of paracetamol ingestion. The current management practices were compared with the best evidence on acute paracetamol poisoning management.

Results: 157 patients were included. The mean ingested dose of paracetamol was 333 mg/kg body weight. Majority of the patients (84%) were transfers. Induced emesis and activated charcoal were given to 91% of patients. N-acetylcysteine was given to 66, methionine to 55, and both to 2. Aclinically important delay in the administration of antidotes was noted; 68% of patients received antidotes after 8 hours of the acute ingestion. Only 31 (26%) had paracetamol levels above the Rumack-Matthew normogram. 74 patients received an antidote despite having a plasma paracetamol level below the toxic level according to the normogram.

Interpretation: Management of acute paracetamol poisoning could be improved by following best available evidence and adapting cheaper methods for plasma paracetamol estimation.

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