Symptoms following a potentially hepatotoxic overdose may include nausea, vomiting, diaphoresis and general malaise. In paracetamol overdosage, regardless of the quantity of paracetamol ingested, acetylcysteine should be administered immediately if 24 hours or less have elapsed from the reported time of ingestion. Acetylcysteine is given by intravenous infusion in an initial dose of 150mg per kg body weight over 15 minutes followed by 50mg per kg over 4 hours and then 100mg per kg over the next 16 hours. Alternatively, methionine 2.5g may be given by mouth every 4 hours to a total of 4 doses. Haemoperfusion may be worthwhile if too much time has elapsed since the poisoning to allow use of acetylcysteine or methionine.
The following additional procedures are recommended: The stomach should be emptied promptly by lavage or by induction of emesis with syrup of ipecac. A serum paracetamol assay should be obtained as early as possible, but no sooner than four hours following ingestion. Liver function studies should be obtained initially and repeated at 24 hours intervals.