Paracetamol poisoning: which nomogram should we use?
OBJECTIVE
To determine the type of paracetamol nomograms used in Australasian EDs. To review the literature to determine the evidence base for existing nomograms.


METHODS
A cross sectional descriptive study via postal survey of all Australasian EDs accredited for specialist emergency medicine training by the Australasian College for Emergency Medicine (ACEM). A literature review using Knowledge Finder search engine was employed.


RESULTS
The response rate was 87%. The most commonly used nomogram had a four-hour treatment level of 1300 mumol/L (69%). A total of 22% of respondents used a four-hour treatment level of 1000 mumol/L. Two departments (3%) treated all patients above the 660 mumol/L line. Eleven departments (15%) did not have a treatment line below 1300 mumol/L.


CONCLUSIONS
Practice varies in Australasian EDs. Patients with paracetamol levels below the 1300 mumol/L have been reported in the literature to develop hepatotoxicity, and deaths have been documented. N-acetylcysteine is extremely safe when used in the recommended dosages.
Reid
Duncan
D
Emergency Department, North Shore Hospital, Shakespeare Rd, Private Bag 93503, Takapuna, New Zealand. Duncan.Reid@WaitemataDHB.govt.nz
Hazell
Wayne
W
D000082:Acetaminophen / Q000506:poisoning*; D018712:Analgesics, Non-Narcotic / Q000506:poisoning*; D001315:Australia; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000592:standards*; D006801:Humans; D009520:New Zealand; D011041:Poisoning / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen