How should you manage an overdose of modified release paracetamol? The answer to this question depends on the size of the overdose:
In all cases, don't forget to give activated charcoal up to four hours after ingestion.
1) Smaller overdoses of less than 10g: Send two paracetamol levels, four hours apart, and start NAC only if a level is above the nomogram treatment line
2) Large overdoses of 10g-30g: Start NAC immediately and complete the two bags regardless of bloods. Simultaneously, send two levels, four hours apart, and double the strength of NAC in the second bag if the level is double the nomogram line.
3) Very large overdoses greater than 30g: Start NAC immediately, complete double strength NAC, send levels, and you might have to give further NAC if the paracetamol level is still raised after 20 hours.
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Please note, this video is not medical advice
