Recent advances in the management of late paracetamol poisoning

Management of early paracetamol poisoning is dependent on prompt administration of N‐acetylcysteine to patients whose plasma concentrations of paracetamol exceed the normal‐risk or high‐risk treatment lines. Paracetamol poisoning presenting after 15 h since ingestion, especially as fulminant hepatic failure, requires meticulous supportive care of organ dysfunction. The putative mechanisms of action of N‐acetylcysteine and its practical use are discussed. The best prognostic marker for paracetamol poisoning in ‘established hepatotoxicity’ is the prothrombin time. Indications for liver transplantation in paracetamol poisoning and exclusion criteria are also discussed.