Summary
Definition
History and exam
Other diagnostic factors
- nausea and vomiting
- risk factors
- right upper quadrant abdominal pain
- jaundice
- hepatomegaly
- altered conscious level
- asterixis
- loin pain
Risk factors
- history of self-harm
- history of frequent or repeated use of medications for pain relief
- glutathione deficiency
- drugs that induce liver enzymes (cytochrome P450 inducers)
Diagnostic investigations
1st investigations to order
- serum paracetamol concentration
- liver function tests
- prothrombin time and INR
- blood glucose
- urea, creatinine, and electrolytes
- venous or arterial blood gas
- full blood count
Treatment algorithm
Contributors
Expert advisers
Emergency Medicine Consultant
Royal London Hospital
Barts Health NHS Trust
Honorary senior lecturer
Queen Mary University
London
UK
Disclosures
JG declares that he has no competing interests.
Senior Clinical Fellow
Newham University Hospital
Barts Health NHS Trust
London
UK
Disclosures
CR declares that she has no competing interests.
BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work has been retained in parts of the content:
Daniel K. Colby, MD
Assistant Professor
Department of Emergency Medicine
UC Davis Health
CA
Alastair Newton, MB ChB, FCEM
Consultant in Emergency Medicine
The Prince Charles Hospital
Brisbane
Australia
Disclosures
DKC and AN declare that they have no competing interests.
Peer reviewers
Consultant Physician
Royal Victoria Infirmary
Newcastle upon Tyne Hospitals NHS Foundation Trust
Honorary Clinical Senior Lecturer in Clinical Pharmacology
Newcastle University
Honorary Consultant Clinical Toxicologist
Public Health England
Director
National Poisons Information Service (Newcastle unit)
Newcastle upon Tyne
UK
Disclosures
RT was an investigator in the Scottish and Newcastle Antiemetic Pre-treatment for paracetamol poisoning (SNAP) study. RT declares that he has no other competing interests.
Editors
Section Editor, BMJ Best Practice
Disclosures
AS declares that she has no competing interests.
Lead Section Editor, BMJ Best Practice
Disclosures
TAO declares that she has no competing interests.
Lead Section Editor, BMJ Best Practice
Disclosures
RW declares that she has no competing interests.
Lead Section Editor, BMJ Best Practice
Disclosures
SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including the National Institute for Health and Care Excellence, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, the National Confidential Enquiry into Patient Outcome and Death, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services.
Comorbidities Editor, BMJ Best Practice
Disclosures
JC declares that she has no competing interests.
Drug Editor, BMJ Best Practice
Disclosures
AM declares that he has no competing interests.
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