OD paracetamol anorexia – part 2

Clinical Pharmacology and Toxicology

Continued from previous question.

The patient stays in A&E and has a 4 hour paracetamol level taken (4 hours after the overdose). The nurse says she’s below the “normal” treatment line and therefore does not require the antidote. Which of the following statements is correct?

Please select 2 answers:

  • She may require treatment because she may have ingested 4 units of alcohol already that day
  • She may require treatment if she has also taken aspirin tablets
  • She may require treatment if she drinks >80 units of alcohol per week
  • She may require treatment because she is anorexic
  • She should be treated irrespective of her paracetamol level until a repeat blood test is done
  • She will require treatment if she normally takes citalopram
  • She will require treatment if she normally takes fluoxetine

Patients with any of the following conditions may require treatment a separate treatment line (a high risk treatment line).

Low BMI / malnourished (HIV anorexia etc)
Taking “enzyme inducers” e.g. rifampicin
St Johns wort

e.g. 4 hour treatment line for treatment high risk= approx 100mg/l paracetamol
e.g. 4 hour treatment line for treatment “normal” risk= approx 200mg/l paracetamol