SNAP (paracetamol toxicity)

In Aug 2021 the treatment of paracetamol toxicity within the trust is due to change, for both adults and children. We will start using the SNAP N-acetyl cysteine (NAC) regime 12hrs, and 2 bags, (instead of the traditional 21hr & 3 bag regime)

Why change?

  • SNAP regime is commonly used around the country
  • Is a recommended treatment regime on Toxbase.org
  • Reduces time our patients require treatment (12 vs 21hr)
  • Has a reduced side effect profile for patients

How will treatment Change?

  • Decision to treat will remain the same and follow Toxbase.org
  • NAC prescription (will be on EPR):
    • Bag 1 – 100mg/kg over 2hrs (in 200ml 5% glucose or 0.9%NaCl adult or 2ml/kg child)
    • Bag 2 – 200mg/kg over 10hrs (in 1000ml 5% glucose or 0.9%NaCl adult or 20ml/kg child)
  • Checking response: Repeat Bloods at 2hrs from end of bag 2 (i.e. 10hrs of treatment)
    • FBC
    • Clotting
    • LFT
    • U+E
    • Paracetamol level 

This should happen on the ward but if there are significant delays it may need doing in ED, and discuss with Med/Paeds regarding further treatment.

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