Paracetamol overdosage is a common problem, but severe poisoning occurs in only a small percentage of cases. A patient who has suffered paracetamol overdosage should be monitored carefully to ensure that a specialist liver unit can be contacted at the earliest signs of severe poisoning for optimal management and transfer. Paracetamol overdosage remains the most common cause of fulminant hepatic failure in the UK, with a mortality rate of 90%, but survival rates can be improved dramatically by specialist intensive care management, and with the advent of transplantation a previously untreatable group of patients can be treated successfully. However, a patient who is inadequately monitored and treated in the early stages after an overdose may deteriorate to an extent that renders them unsalvable by the time they arrive at the specialist centre.