appendix 3:
Paracetamol toxicity treatment nomogram

Patients presenting early should be given activated charcoal
Patients at risk of hepatotoxicity should receive intravenous acetylcysteine
The nomogram below should be used to assess the need for treatment in acute immediate release paracetamol ingestion with a known time of dosing
Different management may be required in cases of modified release paracetamol, massive overdoses, accidental liquid ingestion in children, and repeated supratherapeutic ingestions

Change to a two-bag acetylcysteine infusion regimen. This has similar efficacy to previous three-bag dosing but reduced adverse reactions
Massive overdoses resulting in high paracetamol concentrations more than double the nomogram treatment line should be managed with an increased dose of acetylcysteine
All potentially toxic modified release paracetmol ingestions (≥ 10 g or ≥ 500 mg/kg should receive increased doses of acetylcysteine

Source: Updated guidelines for the management of paracetamol poisoning in Australia & New Zealand. MJA 2020