Massive paracetamol overdoses that result in high paracetamol concentrations more than double the paracetamol nomogram line should be managed with an increased dose of acetylcysteine. 3.

his serum sodium concentration had increased from 142 mmol/L to 165 mmol/L. Soluble paracetamol was withdrawn shortly before he died, and was believed to have contributed to his hypernatremia.

9 points), lactate 4 mmol/l (RFS, 13 points), and norepinephrine treatment (RFS, 12 points). His total score was approximately 179.5 points, and the risk of in-hospital mortality was 78%. Figure 2.

A suspension formulation was substituted and the paracetamol was withdrawn over the next 3 days. His serum sodium concentration stabilised at 161, 159, and 160 mmol/L over these 3 days.