The Kings paper showed that nobody died provided treatment had been commenced within 9
hours of the ingestion (assuming single ingestion, not staggered) however much they had
taken.
The reason for delaying 4 hours is that the absorbtion of paracetamol is erratic and the 4 hour
point is the first point predictive of need for treatment. Remember that the famous line is a risk
of lethality.
There was a poster at BAEM 2 years ago that showed people who had low or undetectable
paracetamol levels were more likely to react to NAC than those who did need it. This is why I
teach NOT to start NAC unless you are at risk of not getting the assay result by 9 hours.
I studied 11 consecutive overdoses that attended once claiming to have taken between 50 and
100 tablets. All 11 had undetectable levels!
You are best not involving the medics until you have to.
Best wishes,
Rowley Cottingham
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