Paracetamol: Repeated ingestion of slightly too much can be fatal -- recognize and treat quickly

November 23, 2011

Repeatedly taking slightly too much paracetamol over time can cause a dangerous overdose that is difficult to spot, but puts the person at danger of dying. Patients may not come to hospital reporting the overdose, but because they feel unwell. This clinical situation needs to be recognized and treated rapidly because these patients are at even greater danger than people who take single overdoses.

These so-called staggered overdoses can occur when people have pain and repeatedly take a little more paracetamol than they should. "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," says Dr Kenneth Simpson who publishes the findings of a recent research project in the .

The problem is that doctors normally assess how much danger an overdose patient is in when they arrive at hospital by taking a blood sample and finding out how much paracetamol is present. In the case of a single dose overdose, the blood sample gives valuable information, but people with staggered overdoses may have low levels of paracetamol in their blood even though they are at high risk of and death.

Working in the University of Edinburgh and the Scottish Unit, Scotland, Dr Simpson and his team analysed data from 663 patients who had been admitted to the Royal Infirmary of Edinburgh between 1992 and 2008 with paracetamol-induced . They found that 161 had taken a staggered overdose, usually to relieve a variety of common pains, such as abdominal or muscular pains, headache and toothache.

"On admission, these staggered overdose patients were more likely to have liver and brain problems, require or help with breathing and were at a greater risk of dying than people who had taken single overdoses," says Simpson. The problem is also worse for people who arrive at hospital more than a day after taking an overdose - they are also at high risk of dying or needing a liver transplant.

"Staggered overdoses or patients presenting late after an overdose need to be closely monitored and considered for the paracetamol antidote, N-acetylcysteine, irrespective of the concentration of paracetamol in their blood," says Simpson.

Because measuring the paracetamol in the blood is such a poor assessment of the patient's status in staggered overdoses or delayed presentation, he believes that doctors urgently need to find new ways of assessing whether a patient can be sent home, need medical treatment to counteract the , or need to be considered for a liver transplant.

Explore further: Scottish data highlight dangerous practice in pediatric paracetamol prescribing

Related Stories

Scottish data highlight dangerous practice in pediatric paracetamol prescribing

May 19, 2011
Many of the prescriptions issued by GPs for paracetamol either give less than recommended doses to older children or exceed recommended doses in young children. Under-dosing may result in insufficient pain relief and over-dosing ...

First study to reveal how paracetamol works could lead to less harmful pain relief medicines

November 22, 2011
Researchers at King's College London have discovered how one of the most common household painkillers works, which could pave the way for less harmful pain relief medications to be developed in the future.

Overdoses of popular painkiller send thousands to ER each year

May 3, 2011
Overdose of the common household drug acetaminophen leads to more than 78,000 emergency department (ED) visits a year, and the majority of the overdoses are intentional, according to a new study from the Centers for Disease ...

Recommended for you

Data revealed under FOI shows benefits of multiple sclerosis drug currently blocked by regulators

August 17, 2017
A drug that is blocked by the EU regulatory system has now been found to improve the quality of life of people with multiple sclerosis (MS), according to a study by Queen Mary University of London (QMUL).

Opioids overused in migraine treatment, regardless of race, study finds

August 17, 2017
African-Americans are more likely to experience debilitating migraine headaches than whites, but a new study probing the issue found no evidence of racial disparities in treatment practices.

Finding better ways to reduce serious drug side effects

August 14, 2017
Many of the medicines we depend on to treat disease—and even to save our lives—pose potentially serious risks along with their benefits. Data from the U.S. Centers for Disease Control and Prevention indicate that about ...

Ultrasound-triggered liposomes for on-demand, local anesthesia

August 10, 2017
Researchers at Boston Children's Hospital have found a new way to non-invasively relieve pain at local sites in the body; such systems could one day improve pain management by replacing addictive opioids and short-lasting ...

Independent pharmacies and online coupons help patients save money on drugs

August 8, 2017
Uninsured patients or those with limited prescription drug coverage can save significant money by buying their drugs at independent pharmacies instead of big box, grocery or chain drug stores and by using discount coupons, ...

New study generates more accurate estimates of state opioid and heroin fatalities

August 7, 2017
Although opioid and heroin deaths have been rising dramatically in the U.S., the magnitude of the epidemic varies from state to state, as does the relative proportion of opioid vs heroin poisonings. Further complicating the ...

6 comments

Adjust slider to filter visible comments by rank

Display comments: newest first

Nerdyguy
1.2 / 5 (6) Nov 23, 2011
"Paracetamol: Repeated ingestion of slightly too much can be fatal -- recognize and treat quickly"

I had to look up "paracetamol", and wondered why the article made no mention of the drug's usage. So, I had a chuckle when I found out it was only acetaminophen, which is the common usage in the U.S.
antialias_physorg
5 / 5 (1) Nov 23, 2011
Probably because phyorg pulled this out of a British journal. Paracetamol is the going name of the drug in Europe.
Explaining what it is would be like explaining to people what Aspirin is.

However, the article does state the usage in the very first sentence.
when people have pain
Nerdyguy
1 / 5 (5) Nov 23, 2011
Probably because phyorg pulled this out of a British journal. Paracetamol is the going name of the drug in Europe.
Explaining what it is would be like explaining to people what Aspirin is.

However, the article does state the usage in the very first sentence.
when people have pain


Oh, yes, I got that. I forgot to mention I thought it was odd that it came from Wiley, which is in the U.S., but I'm guessing they used a local reporter. I find it interesting to read international news from different sources. As long as it's in English, or occasionally French or Spanish, I'm OK. But, the various usages of words in the "Queen's English", Canadian English, American English, and Australian English are fascinating to me. It's a constant reminder of how languages are an evolving, living thing.
kaasinees
not rated yet Nov 23, 2011
Evolving languages are good and all. But forking languages are a pain in the ass. It is one of the many negative results of tribalism.
dirk_bruere
not rated yet Nov 23, 2011
Codeine is far safer
rwinners
not rated yet Nov 24, 2011
And morphine is even better yet, dirk...

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.