A 44 year old man presents 12 hours following a Paracetamol overdose The Paracetamol Nomogram on its own is not validated for presentations after 8 hours.

Approach:

R – RESUSCITATION – ABC approach, attend to immediate life threats. Unlikely unless severe established toxicity.

R – RISK ASSESSMENT – Drug, dose, timing, clinical status, comorbidities

S – SUPPORTIVE CARE –

I – INVESTIGATION – this patient must have an ALT level, other investigations depend on clinical status and may include INR, Glucose, UEC, ABG

D – DECONTAMINATION – AC is not usually given for isolated Paracetamol overdoses because of the availability of an effective antidote (NAC)

E – ENHANCE ELIMINATION

A – ANTIDOTE – based on clinical picture and ALT level

D – DISPOSITION – EAU/ICU/Psych

Psychiatry evaluation