It is 03:00, you are called as a febrile infant has received an accidental tenfold intravenous paracetamol overdose. What do you do?

Like many countries, the UK has a well-established poisons information centre first established in 1962. The UK National Poisons Information Service (NPIS) is now a network of dedicated poisons units to support patients and healthcare professionals. The first paracetamol deaths were reported in the 1960s, and by the 1970s child fatalities were also reported, but fortunately, acetylcysteine was found to be effective.1 Today paracetamol enquiries to NPIS continue to vastly outnumber any other medication. Between 2002 and 2012, paracetamol overdose secondary to medication errors was the leading cause of paediatric acute liver failure in Australia and New Zealand.2

Intravenous paracetamol was first introduced in the UK in 2003 and is used widely in paediatric units. The intravenous route is licensed where there is an urgent need to treat …