Paracetamol poisoning
Risk assessment by dose and the single-line Australian nomogram, the two-bag acetylcysteine regimen, modified-release, massive and repeated supratherapeutic ingestions, liver failure criteria, and the 2025 pack-size changes.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- The commonest drug taken in deliberate self-poisoning in Australia and the commonest cause of acute liver failure. Treated early, almost nobody dies.
- Risk assessment rests on dose, timing and formulation. Ask for each, then decide whether the nomogram applies.
- Acetylcysteine is close to 100% protective if started within 8 hours. Never wait for a level beyond that point.
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Sources
- Chiew AL, Reith D, Pomerleau A et al. Updated guidelines for the management of paracetamol poisoning in Australia and New Zealand. Med J Aust 2020;212:175-83AU/NZMedical Journal of Australia, 2020
- Therapeutic Guidelines: Toxicology and Toxinology (December 2024 update, including revised repeat-level advice for liquid paracetamol in young children)AU/NZTherapeutic Guidelines Limited, 2024
- Hoegberg LCG, Gosselin S, Buckley NA et al. Recommendations from the Clinical Toxicology Recommendations Collaborative on the administration of activated charcoal in acute oral overdose. Clin Toxicol 2026;64:419-75Clinical Toxicology, 2026
- Gosselin S, Juurlink DN, Kielstein JT et al. Extracorporeal treatment for acetaminophen poisoning: recommendations from the EXTRIP workgroup. Clin Toxicol 2014;52:856-67Clinical Toxicology, 2014
- Chidiac AS, Buckley NA, Noghrehchi F et al. Paracetamol poisoning admissions and long-term outcomes in New South Wales (PAVLOVA-3). Lancet Reg Health West Pac 2026;71:101886AU/NZThe Lancet Regional Health Western Pacific, 2026
- Chiew AL, James LP, Isbister GK et al. Early acetaminophen-protein adducts predict hepatotoxicity following overdose (ATOM-5). J Hepatol 2020;72:450-62AU/NZJournal of Hepatology, 2020
- Anand S, Buckley NA, Stathakis P et al. Effects of fomepizole on acetaminophen oxidative metabolism: a randomized crossover study in human volunteers. Clin Pharmacol Ther 2026;120:795-805AU/NZClinical Pharmacology and Therapeutics, 2026
- Cairns R et al. The impact on poisonings of up-scheduling of modified release paracetamol to Schedule 3 (pharmacist only medicine). Med J Aust 2023;218:412-14AU/NZMedical Journal of Australia, 2023
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy