Paracetamol is a widely used effective analgesic and antipyretic agent. At the same time, it is also the most common cause of drug intoxication and acute liver failure in the Western world. Management guidelines from the various poison centres are similar in terms of treatment of early presenters, but evidence for guiding management for repeated ingestion or late presenters is scant. Antidote therapy with N-acetylcysteine is the cornerstone of paracetamol poisoning, however, better patients risk assessment models are needed. New protocols for administration of n-acetylcysteine have shown a better safety profile and the same efficacy as the standard protocol to prevent significant liver damage.