• Duncan Reid and Wayne Hazell.
• Emergency Department, North Shore Hospital, Shakespeare Rd, Private Bag 93503, Takapuna, New Zealand. Duncan.Reid@WaitemataDHB.govt.nz
• Emerg Med (Fremantle). 2003 Oct 1;15(5-6):486-96.

ObjectivesTo determine the type of paracetamol nomograms used in Australasian EDs. To review the literature to determine the evidence base for existing nomograms.MethodsA cross sectional descriptive study via postal survey of all Australasian EDs accredited for specialist emergency medicine training by the Australasian College for Emergency Medicine (ACEM). A literature review using Knowledge Finder search engine was employed.ResultsThe response rate was 87%. The most commonly used nomogram had a four-hour treatment level of 1300 mumol/L (69%). A total of 22% of respondents used a four-hour treatment level of 1000 mumol/L. Two departments (3%) treated all patients above the 660 mumol/L line. Eleven departments (15%) did not have a treatment line below 1300 mumol/L.ConclusionPractice varies in Australasian EDs. Patients with paracetamol levels below the 1300 mumol/L have been reported in the literature to develop hepatotoxicity, and deaths have been documented. N-acetylcysteine is extremely safe when used in the recommended dosages.

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