For any urgent enquiries please contact our customer services team who are ready to help with any problems. Paracetamol overdose in adults View PDF external link opens in a new window. Last reviewed: 13 Oct Last updated: 17 Jul Therapeutic excess: Excessive paracetamol taken with intent to treat pain or fever and without self-harm intent. Other diagnostic factors nausea and vomiting risk factors right upper quadrant abdominal pain jaundice hepatomegaly altered conscious level asterixis loin pain Full details.
Risk factors history of self-harm history of frequent or repeated use of medications for pain relief glutathione deficiency drugs that induce liver enzymes cytochrome P inducers Full details.
Investigations to consider salicylate level urinalysis urine drug screen Full details. Acknowledgements, BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work has been retained in parts of the content: Daniel K. Toxbase: paracetamol overdose external link opens in a new window Self-harm in over 8s: short-term management and prevention of recurrence external link opens in a new window More guidelines.
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.
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Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Abstract. What can be done to reduce mortality from paracetamol overdoses? A patient interview study. Simkin , S. Oxford Academic. Revision received:. Cite Cite S. Select Format Select format. Permissions Icon Permissions. Abstract Background: Paracetamol acetaminophen is the most common self-poisoning agent in the UK and a leading cause of fatal hepatotoxicity.
Figure 1. Open in new tab Download slide. Flow chart of recruitment to the study. Open in new tab. Table 2 Characteristics of the overdose. Table 3 Reasons for taking the overdose a. To die 46 Detailed analyses of self-poisoning episodes presenting to a large regional teaching hospital in the UK. Google Scholar Crossref. Search ADS. Epidemiology and trends in non-fatal self-harm in three centres in England, to Use of paracetamol acetaminophen for suicide and non-fatal poisoning: world-wide patterns of use and misuse.
Google Scholar PubMed. Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study. Estimates of acetaminophen paracetamol -associated overdoses in the United States. Guidelines for the management of paracetamol poisoning in Australia and New Zealand — explanation and elaboration.
Acute liver failure in a metropolitan area in Germany: a retrospective study — Paracetamol overdosage: pharmacological considerations and clinical management. UK legislation on analgesic packs: before and after study of long term effect on poisonings.
Why patients choose paracetamol for self poisoning and their knowledge of its dangers. Paracetamol self-poisoning. Characteristics, prevention and harm reduction. Use of paracetamol for suicide and non-fatal poisoning in the UK and France: Are restrictions on availability justified? Effects of legislation restricting pack sizes of paracetamol and salicylates on self poisoning in the United Kingdom: before and after study.
Paracetamol pack size restriction: the impact on paracetamol poisoning and over-the-counter supply of paracetamol, aspirin and ibuprofen. Interrupted time-series analysis of regulations to reduce paracetamol acetaminophen poisoning. Impact of paracetamol pack size restrictions on poisoning from paracetamol in England and Wales: an observational study.
Paracetamol acetaminophen pack size restrictions and poisoning severity: time trends in enquiries to a UK poisons centre. Restricting paracetamol in the United Kingdom to reduce poisoning: a systematic review. Legislation restricting paracetamol sales and patterns of self-harm and death from paracetamol-containing preparations in Scotland. Referral patterns and social deprivation in paracetamol-induced liver injury in Scotland.
Severity of overdose after restriction of paracetamol availability: retrospective study. Paracetamol availability and recent changes in paracetamol poisoning: is the legislation limiting availability of paracetamol being followed? Advertising complaint — Home Bargains Stores, multiple sales of paracetamol — August Deliberate self-harm in Oxford, a time of change in patient characteristics. Value of measuring suicidal intent in the assessment of people attending hospital following self-poisoning or self-injury.
Ease of access is a principal factor in the frequency of paracetamol overdose. Paracetamol availability in pharmacy and non-pharmacy outlets in Dublin, Ireland. Effects of a drug overdose in a television drama on presentations to hospital for self poisoning: time series and questionnaire study. Medicinal Products Control of Paracetamol Regulations, 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.
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