Repeated supratherapeutic ingestion of paracetamol refers to staggered dosing with therapeutic intent of > 4 g /day in adults or > 60 mg/kg/day in children. In adults, it usually occurs in context of self-medication for acute pain or exacerbations of chronic pain. In children, it is usually a therapeutic error. Repeated supratherapeutic ingestion is responsible for all deaths related to paracetamol in children less than six years of age and up to 15% of those in adults. Standard nomograms do not apply. The decision to treat is based on an estimation of dose in conjunction with biochemical testing (serum paracetamol level and hepatic aminotransferase levels).
References
- Daly FS, Fountain JS, Murray L et al. Guidelines for the management of paracetamol poisoning in Australia and New Zealand – explanation and elaboration. A consensus statement from toxicologists consulting to the Australasian Poisons Information Centres. Medical Journal of Australia 2008; 188:296-301.
- Dart RC, Erdman AR, Olson KR et al. Acetaminophen poisoning: an evidence-based consensus guideline for out-of-hospital management. Clinical Toxicology 2006; 44:1-18.
- Daly FFS, O’Malley GF, Heard K et al. Prospective evaluation of repeated supratherapeutic acetaminophen (paracetamol) ingestion. Annals of Emergency Medicine 2004; 44(4):393-398.
About Mike Cadogan
