What are the criteria for referring a patient with paracetamol overdose to secondary care?

Criteria for referring a patient with paracetamol overdose to secondary care include:

• Any patient presenting with a significant paracetamol overdose, especially if the amount ingested exceeds the recommended toxic threshold or if the timing of ingestion is uncertain.
• Patients showing signs of liver dysfunction or abnormal liver function tests, as these indicate potential hepatotoxicity requiring specialist management.
• Patients with evidence of altered mental state, coagulopathy, or metabolic acidosis, which suggest severe poisoning and complications.
• Patients who require treatment with N-acetylcysteine (NAC) for antidotal therapy, which is typically administered in secondary care settings.
• Patients with risk factors such as chronic alcohol use, malnutrition, or concomitant use of enzyme-inducing drugs, which increase the risk of toxicity and necessitate specialist assessment.
• Any patient with delayed presentation (more than 8 hours post-ingestion) or those who have taken repeated supratherapeutic doses over more than 24 hours.

Referral should be prompt to ensure timely administration of antidote and monitoring for complications.