In this episode, Elizabeth and Matthew discuss Paracetamol Toxicity with Dr Ng Mingwei. We cover the 2 Bag versus 3 Bag regimens, when to stop NAC, RSTI, what to do for anaphylactoid reactions, massive paracetamol OD, and the paracetamol multiplication product.

Timestamps 

01:57 Case #1

03:01 Mechanism of Toxicity 

04:00 Risk profiling and Rumack-Matthew Nomogram 

06:20 Case #2 

08.25: NAC/ 2 bag vs 3 bag regimen 

11:24 Paracetamol Guidelines

12:56 Paracetamol Multiplication Product* 

*Note: The study quoted was in a population treated with NAC. 

14:53 Anaphylactoid reactions

15:37 When to cease NAC

16:24 RSTI

18:04 Massive Paracetamol OD

19:58 Liver transplant

20:47 3 Takeaways 

Thank you for listening!

Credits

Music: Life-line by Colorful Sound via Pixabay

SGH Podcast Studio

SEMS

Dr Mong Rupeng for reviewing this episode

References

1. Chiew AL, Reith D, Pomerleau A, Wong A, Isoardi KZ, Soderstrom J, Buckley NA. Updated guidelines for the management of paracetamol poisoning in Australia and New Zealand. Med J Aust. 2020 Mar;212(4):175-183. doi: 10.5694/mja2.50428. Epub 2019 Dec 1. PMID: 31786822.
2. Wong A, Isbister G, McNulty R, Isoardi K, Harris K, Chiew A, Greene S, Gunja N, Buckley N, Page C, Graudins A. Efficacy of a two bag acetylcysteine regimen to treat paracetamol overdose (2NAC study). EClinicalMedicine. 2020 Mar 19;20:100288. doi: 10.1016/j.eclinm.2020.100288. PMID: 32211597
3. Wong A, Sivilotti MLA, Graudins A. Accuracy of the paracetamol-aminotransferase multiplication product to predict hepatotoxicity in modified-release paracetamol overdose. Clin Toxicol (Phila). 2017 Jun;55(5):346-351. doi: 10.1080/15563650.2017.1290253. Epub 2017 Feb 15. PMID: 28421844. 

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