Treatment of Acute Paracetamol Overdose: A Comprehensive Overview

PURPOSE: Given its widespread availability, paracetamol (acetaminophen and p-aminophenol) is frequently ingested in overdose, making paracetamol poisoning one of the most common drug-induced poisonings worldwide.

METHODS: A comprehensive overview of recent developments in the treatment of acute paracetamol poisoning is presented, with the aim of improving clinicians' understanding of the diagnosis and treatment of patients with paracetamol poisoning.

RESULTS: Paracetamol's pharmacokinetics and toxicokinetics are examined, along with its toxicity (doses and early concentrations); massive overdose or high-risk ingestion; treatment of specific populations such as children, pregnant women, and patients with obesity; prognostic markers of paracetamol toxicity; gastrointestinal decontamination; renal replacement therapy; antidotal therapy with acetylcysteine dosing regimens; adverse reactions; and acetylcysteine alternatives or adjunctive therapies.

CONCLUSIONS: Although paracetamol poisoning seems straightforward in terms of risk assessment and treatment, the developments in its diagnosis and treatment reveal that this field is constantly evolving. Multiple factors must be considered in patients with paracetamol poisoning, making its treatment challenging. This comprehensive overview aims to address these challenges.