In Aug 2021 the treatment of paracetamol toxicity within the trust is due to change, for both adults and children. We will start using the SNAP N-acetyl cysteine (NAC) regime 12hrs, and 2 bags, (instead of the traditional 21hr & 3 bag regime)

Why change?

• SNAP regime is commonly used around the country
• Is a recommended treatment regime on Toxbase.org
• Reduces time our patients require treatment (12 vs 21hr)
• Has a reduced side effect profile for patients

How will treatment Change?

• Decision to treat will remain the same and follow Toxbase.org
• NAC prescription (will be on EPR):
  • Bag 1 – 100mg/kg over 2hrs (in 200ml 5% glucose or 0.9%NaCl adult or 2ml/kg child)
  • Bag 2 – 200mg/kg over 10hrs (in 1000ml 5% glucose or 0.9%NaCl adult or 20ml/kg child)
• Checking response: Repeat Bloods at 2hrs from end of bag 2 (i.e. 10hrs of treatment)
  • FBC
  • Clotting
  • LFT
  • U+E
  • Paracetamol level 

This should happen on the ward but if there are significant delays it may need doing in ED, and discuss with Med/Paeds regarding further treatment.