Red flags
- Staggered ingestion
- Unknown time / >24 h ingestion
- Hepatotoxicity signs (RUQ pain, jaundice, encephalopathy)
First steps
- Time of ingestion, dose, formulation
- Activated charcoal if <1 h and >150 mg/kg
- Bloods including paracetamol level at 4 h
Key investigations
- Paracetamol level at 4 h post-ingestion
- LFT, INR, U&E, glucose, ABG, VBG
Differentials
- Co-ingestion (opioids, aspirin, alcohol)
Initial management
- Plot level on Rumack-Matthew nomogram (UK 100-line)
- NAC 21-h regimen if above line, staggered, unknown time, or high risk
- SNAP 12-h regimen alternative
- King's College criteria — transplant referral
Referral
- Hepatology / transplant centre if fulminant
AI clinical assessment
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This tool is for educational and clinical support only. It does not replace professional medical judgment or institutional protocols.
