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What is your initial management plan?
Her paracetamol level comes back at 150mg/l. This is between the normal risk (200mg/l) and the high risk (100mg/l) lines on the UK nomogram at four hours.
a. Do you treat her with N-Acetylcysteine?
b. Does her increased alcohol consumption affect your decision? Why?
c. She refuses to allow you to place and intravenous cannula. Are there any alternatives to NAC?
You decide to start NAC at the rates advised in the BNF. 40 minutes later, she is flushed and itchy. What are your actions?