The clinical value of screening for paracetamol in patients with acute poisoning

In this retrospective study, we determined the clinical value of screening for paracetamol in 294 Chinese patients with acute poisoning presenting to the general medical wards at the Prince of Wales Hospital between January 1992 and June 1993. Of the 86 patients suspected of having ingested paracetamol, eight had levels above the recommended 'treatment line'. Of the 208 patients with no suspected paracetamol ingestion, four were found to have elevated but non-toxic plasma levels. The incidence of missed, potentially serious paracetamol poisoning in our patients with no suspected paracetamol ingestion is extremely uncommon. Routine screening of all patients with acute poisoning for toxic plasma paracetamol concentrations is therefore not indicated and should never be a substitute for thorough history taking and physical examination.