Paracetamol overdose is common and may occur accidentally or in the context of self-harm. Significant overdose can result in liver failure if not promptly treated with the antidote.
Paracetamol is usually taken by mouth and is available in various ways, such as in tablet, caplet, soluble and liquid forms. They will pass to the stomach and intestine into the body and lead to pain relief and lowering of a high temperature fever. After this, paracetamol is inactivated before being removed from the body. As a result a small amount of a toxic compound n-acetyl-p-benzoquinone imine, or NAPQI is formed in the liver but is quickly detoxified by a substance called glutathione.
However in overdose the stores of glutathione can be depleted so that there isn't enough to remove the increased amounts of NAPQI. Paracetamol is the most common medicine taken in overdose. It can lead to liver failure in a number of days, despite using medication to protect the liver. Liver failure can be fatal. There are many reasons for someone to take an overdose. This could be to end one's life or to cause serious self-harm. An overdose can also be taken accidentally - for example, toddlers and people with poor eyesight.
In some, the act of taking an overdose is a spur-of-the-moment thing, whilst in others it can be pre-planned. Those who have pre-planned may have stockpiled medication, sorted out their affairs such as writing a will and also written a suicide note. Some people take higher-than-recommended doses of paracetamol for pain over several days.
They may not intend to kill themselves, and occasionally may not even realise they are harming themselves until they begin to feel unwell. Paracetamol is widely available from shops and is present in most homes. The government has made rules to limit how much can be bought in one go, which may help reduce the number of overdoses. It is reasonably easy to take and so the government had also ruled that it should only be available in blister packs which can mean the tablets are trickier to get out.
There may be no symptoms for the first day. A feeling of sickness nausea and being sick vomiting may occur a few hours after taking the overdose. After 24 hours there may be pain under the ribs on the right side where the liver is and there may be yellowing of the whites of the eyes and the skin jaundice. Other features include:. There is an antidote to paracetamol and accessing this as soon as possible is essential. The drug N-acetylcysteine is given intravenously through a vein.
It protects the liver from damage, this may work via increasing glutathione levels. It is most effective within 8 hours of an overdose but can be used up to and occasionally beyond 24 hours. If someone presents to Accident and Emergency within one hour of ingesting a significant amount of paracetamol, they may be treated with activated charcoal. This is taken in liquid form and binds to paracetamol in the gastrointestinal tract reducing the amount which is absorbed.
Doctors will discuss cases of paracetamol overdose with the National Poisons Information Service if there is any doubt as to whether treatment is required. Around 1 in paracetamol overdoses result in liver failure. Liver failure can be fatal and the only cure is a liver transplant. The British Liver Trust say that emergency liver transplantation is uncommon and only 20 to 30 are carried out each year in the UK. If someone is very unwell with an overdose they may require treatment in an intensive care unit.
It is common for people to take a variety of different medications when they overdose and each can have its own complications and treatments. Everyone who has been admitted to hospital with an overdose needs to be seen by the psychiatric team before they are discharged home.
Understanding why they took the overdose and what help and support they need is essential. It is important to ensure they are not at risk from harming themselves again and have ongoing treatment arranged for their mental health. There is ongoing research to find new treatments for paracetamol overdose that will be effective beyond the eight-hour window that current treatment with N-acetylcysteine offers. Parenting Mental health Healthy eating Conditions Follow. Type keyword s to search.
Chinnapong Getty Images. Paracetamol dosage The recommended adult dose of paracetamol is 1 gram, four times a day. Related Story. This content is created and maintained by a third party, and imported onto this page to help users provide their email addresses.
You may be able to find more information about this and similar content at piano. Dr Simpson said: "They haven't taken the sort of single-moment, one-off massive overdoses taken by people who try to commit suicide, but over time the damage builds up, and the effect can be fatal. It's easy to take more than intended, so if in doubt consult your pharmacist.
Meanwhile, researchers at King's College London and Lund University in Sweden say they have discovered precisely how paracetamol works in the body. Now that they understand this principal mechanism, scientists can start to look for molecules that work in the same way to effectively relieve pain, but are less toxic and will not lead to serious complications following overdose.
Child paracetamol dosages revised. Painkillers 'risky in pregnancy'.
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