Management of acute paracetamol poisoning in a tertiary care hospital

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. Nacetylcysteine was given to 66, methionine to 55, and both to 2. A clinically 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.