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. 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.
