Paracetamol Poisoning – Information for patients receiving SNAP protocol

You have been given this patient information leaflet as you have been assessed and will be receiving treatment in hospital following a paracetamol overdose.

Please read this through before you leave hospital and speak to a doctor or nurse caring for you if you have any further questions.

What are the risks of a paracetamol overdose?

Paracetamol is a common painkiller that is normally safe but can be harmful to the liver and, in rare cases, the kidneys, when taken in amounts above the recommended doses.

What are the risks to me?

You have been assessed by the medical team and based on the information you have provided and the result of blood tests taken you need some treatment to prevent damage to your liver.

What treatment will I be given?

The treatment is called acetylcysteine and it is given through an intravenous infusion (fluid given via a cannula – thin plastic tube into your vein). In this hospital all patients needing treatment with acetylcysteine for a paracetamol overdose are treated using the Scottish and Newcastle Acetylcysteine Protocol – this is referred to as ‘SNAP’ treatment.

This is a new way of giving acetylcysteine. Experts from the National Poisons Information Service and specialist units with experience of treating patients with paracetamol overdose believe that SNAP is better because:

• It uses the same dose of acetylcysteine but involves fewer infusions than the old method (2 rather than 3).

• It requires a shorter time on the drip for most patients (12 hours rather than 21 hours).

• Side effects such as itching and vomiting are much less common.

• It is likely to be as effective at preventing liver damage as the old method of giving acetylcysteine.

There have been concerns that by giving acetylcysteine in this way some patients could develop liver injury or liver failure subsequent to discharge. There is little evidence of this happening and the risks of not receiving treatment are much greater.

We will check your blood tests after you have had the acetylcysteine to be sure you are not at risk of developing liver problems. These blood tests will be taken at the end of the second acetylcysteine infusion and if necessary repeated so we have results from a blood test taken at least 24 hours after paracetamol was last taken.

If there are any problems with these blood tests the clinical team will discuss the results with you and you may need to be treated with more acetylcysteine.

Is there anything I should do before I leave hospital?

We will only discharge you when your blood tests show you are not at risk of developing liver problems. It is very important the information you have given us about the tablets you took is as accurate as possible, as the doctors and nurses have used this information when assessing you and your risk of liver damage.

In particular, are you certain:

• When you took the tablets?
• The number of tablets that you took?
• Whether you took the tablets all at once or over more than an hour?

If you have forgotten to tell us any of this information or think something you have already told us may not be correct, you should inform the doctor or nurse immediately, before you leave hospital.

You should ask your doctor or nurse how long to avoid paracetamol.

What should I do after I leave hospital?

You will only be discharged from the hospital when the team looking after you feel the risk of developing liver damage is very low, based on the information you provided and the blood test results. We do not think you will be at risk of any long-term health effects.

However, if you develop any of the following symptoms you must seek medical advice immediately:

• Abdominal (stomach) pain, nausea, vomiting (sickness).
• Yellow discolouration of the skin or whites of the eyes (jaundice).
• Severe headache, confusion or drowsiness.
• Passing no urine at all for the past 8 hours.

What should I do if I have a problem?

If you have any further questions or require further medical help you should contact the Emergency Assessment Unit (see contact numbers).

Contact Numbers

University Hospital of North Tees

Emergency Assessment Unit

Telephone: 01642 382801 or 01642 382701.

NHS 111 for non-emergency, or 999 if emergency care is needed.

Further Information

NHS Choices

Provides online information and guidance on all aspects of health and healthcare, to help you make choices about your health. The NHS website – NHS (www.nhs.uk)

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

Opening hours: Monday to Friday, 9:30am to 4:00pm

Email: [email protected]

Out of hours

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.

Telephone: 01642 617617

Data protection and use of patient information

The Trust has developed Data Protection policies in accordance with Data Protection Legislation (UK General Data Protection Regulations and Data Protection Act 2018) and the Freedom of Information Act 2000. All of our staff respect these policies and confidentiality is adhered to at all times. If you require further information on how we process your information please see our Privacy Notices.

Telephone: 01642 383551

Email: [email protected]

Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]