Increasing NAC dose efficacy in large paracetamol overdoses
The term ‘massive overdose’ has been used by some as a term to cover this kind of patient, but we currently lack hard clinical trial evidence on this approach. While there are case reports using increased NAC doses to date there has been a lack of a clear research strategy. These cases are rare and will therefore require multicentre studies, making expense a significant barrier to clinical trials under current UK regulations. There is nevertheless clear theoretical base for such an approach as discussed above.
The if the patient presents with a large overdose, and presentation is delayed beyond 8-12 h, making the need to treat more urgent a dose corrected for body weight of
500mg/kg body weight seems an alternative simple cut-off for considering a higher, doubled intensity treatment.16 This has the advantage of simplicity as opposed to more complex algorithms with varying NAC doses across a range of higher
paracetamol doses.6,17