Information
Editors
Paracetamol Poisoning
Essentials
- Paracetamol poisoning can cause severe liver damage. If an overdose is suspected, the patient should be transferred promptly to a unit where examination and treatment can be performed with monitoring.
- A national or otherwise relevant poison information center should be consulted without hesitation.
- Liver enzymes and paracetamol levels should be measured.
- Treatment with acetylcysteine should be started immediately in the case of severe poisoning, otherwise depending on the paracetamol concentration.
- Paracetamol alone or as a causative agent in mixed poisoning is one of the most common causes of severe drug poisoning.
- Severe poisoning is in most cases deliberate.
- Combination products (with codeine, for instance) can cause parallel paracetamol poisoning in people looking for opioids.
- Acute liver damage of originally unknown cause is often due to paracetamol.
- A dose of paracetamol ≥ 150 mg/kg is hepatotoxic.
- For adults weighing 70 kg, more than 10 g within 24 h or more than 6 g daily for at least 2 days
- Even smaller amounts may damage the liver in risk groups (alcohol dependence, HIV, undernutrition, liver failure or high aminotransferase concentrations, medication affecting hepatic metabolism, poor diuresis).
- Because of the slow emergence of liver damage, low serum paracetamol levels do not exclude paracetamol as the causative agent.
- Special attention is required in poisoning caused by slow-release paracetamol preparation (so-called "Extend" products), where the concentration may increase even for a very long time and the kinetics do not follow the nomogram.
Symptoms and findings
- Primary symptoms and findings (0-24 h)
- Nausea, vomiting, abdominal pain
- Hypokalaemia and metabolic acidosis
- Later symptoms (24-72 h)
- Abdominal pain, liver tenderness
- Increased aminotransferase levels as a sign of hepatocellular injury; PT% decreasing (INR and PT [in seconds] increasing) and at its lowest at 3-4 days, unless the liver regenerates.
- Permanent liver damage will develop in 1-4 days.
- Signs of liver damage
- Decreased kidney function
- Disturbed brain function
- Jaundice
- Hypoglycaemia