When and how to treat paracetamol overdoses
Paracetamol poisoning is the commonest acute poisoning in most European countries and in North America, and is the most frequent cause of acute liver injury requiring transplantation. Treatment of poisoning is based on an understanding of the mechanisms and time-frames of toxicity, The key problem is balancing the risk from the overdose to the need for treatment with acetylcysteine. There is no standard international agreement on this, and the reasons and implications of different approaches will be discussed. Finally recent work on a new treatment regimen, and novel toxicity markers will be described.