Extracorporeal interventions included charcoal haemoperfusion compared with conventional treatment (supportive care including gastric lavage, intravenous fluids, and fresh frozen plasma) in one trial with 16 participants. There seemed to be no difference between gastric lavage and ipecacuanha, but gastric lavage and ipecacuanha seemed more effective than no treatment (very low quality of evidence). Activated charcoal seemed to have the best risk:benefit ratio among gastric lavage, ipecacuanha, or supportive treatment if given within four hours of ingestion. Activated charcoal seemed to reduce the absorption of paracetamol, but the clinical benefits were unclear. The trial presented results on lowering plasma paracetamol levels. Interventions that prevent absorption, such as gastric lavage, ipecacuanha, or activated charcoal were compared with placebo or no intervention and with each other in one four‐armed randomised clinical trial involving 60 participants with an uncertain randomisation procedure and hence very low quality. Accordingly, the quality of evidence was low or very low for all comparisons. Furthermore, all the trials were at high risk of bias. All trial analyses lack power to access efficacy. Each of the remaining comparisons included outcome data from one trial only and hence their results are presented as described in the trials. Of the 11 trials, only two had two common outcomes, and hence, we could only meta‐analyse two comparisons. There were no randomised clinical trials of agents that inhibit cytochrome P‐450 to decrease the activation of the toxic metabolite N‐acetyl‐ p‐benzoquinone imine. The variety of interventions studied included decontamination, extracorporeal measures, and antidotes to detoxify paracetamol's toxic metabolite which included methionine, cysteamine, dimercaprol, or acetylcysteine. We identified 11 randomised clinical trials (of which one acetylcysteine trial was abandoned due to low numbers recruited), assessing several different interventions in 700 participants.
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