section name header

Information

Editors

JuhaValli
MikkoParry

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 HASH(0x2f82cc8) 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