In this episode, Elizabeth and Matthew discuss Paracetamol Toxicity with Dr Ng Mingwei. We cover the 2 Bag versus 3 Bag regimens, when to stop NAC, RSTI, what to do for anaphylactoid reactions, massive paracetamol OD, and the paracetamol multiplication product.Timestamps 01:57 Case #103:01 Mechanism of Toxicity 04:00 Risk profiling and Rumack-Matthew Nomogram 06:20 Case #2 08.25: NAC/ 2 bag vs 3 bag regimen 11:24 Paracetamol Guidelines12:56 Paracetamol Multiplication Product* *Note: The study quoted was in a population treated with NAC. 14:53 Anaphylactoid reactions15:37 When to cease NAC16:24 RSTI18:04 Massive Paracetamol OD19:58 Liver transplant20:47 3 Takeaways Thank you for listening!CreditsMusic: Life-line by Colorful Sound via PixabaySGH Podcast StudioSEMSDr Mong Rupeng for reviewing this episodeReferencesChiew AL, Reith D, Pomerleau A, Wong A, Isoardi KZ, Soderstrom J, Buckley NA. Updated guidelines for the management of paracetamol poisoning in Australia and New Zealand. Med J Aust. 2020 Mar;212(4):175-183. doi: 10.5694/mja2.50428. Epub 2019 Dec 1. PMID: 31786822.Wong A, Isbister G, McNulty R, Isoardi K, Harris K, Chiew A, Greene S, Gunja N, Buckley N, Page C, Graudins A. Efficacy of a two bag acetylcysteine regimen to treat paracetamol overdose (2NAC study). EClinicalMedicine. 2020 Mar 19;20:100288. doi: 10.1016/j.eclinm.2020.100288. PMID: 32211597Wong A, Sivilotti MLA, Graudins A. Accuracy of the paracetamol-aminotransferase multiplication product to predict hepatotoxicity in modified-release paracetamol overdose. Clin Toxicol (Phila). 2017 Jun;55(5):346-351. doi: 10.1080/15563650.2017.1290253. Epub 2017 Feb 15. PMID: 28421844. All recordings should not be taken by users/ audience as medical advice. Everyone is encouraged to see their physicians for proper medical consultation. Any comments or feedback? Suggestions for future episodes? Send us a message!https://semspodcast.buzzsprout.com/

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