A scientific article by Dr. Hanadi Hadi entitled PARACETAMOL POISONING Date: 18/01/2023 | Views: 412

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Paracetamol Poisoning
An important reason why paracetamol (acetaminophen) is widely used to reduce
pain and fever is that it does not cause the gastrointestinal toxicity of the nonsteroidal
anti-inflammatory drugs. However, acetaminophen can cause liver toxicity including
serious liver failure, when the patient exceeds the total recommended dosage of less
than 4 g/day.
The mechanism of this toxicity is well known and results from the depletion of
endogenous glutathione and subsequent shunting of paracetamol metabolism from
benign to toxic pathways . The risk is greater when the liver is compromised by
disease or excessive alcohol use.
Cases of paracetamol liver toxicity can be classified as intentional and unintentional.
Intentional paracetamol overdosing involving single ingestion is a common form of
suicide attempt due to its low cost and accessibility. Unintentional overdoses, which
are common in adults and children, account for more than 50% of all cases and is
primarily due to therapeutic misuse and excessive dosing over a period of time;
usually more than 3 days. Moreover, these “therapeutic misadventures” are also
attributed to the use of multiple non-prescription combined formulations containing
The problem with these over-the-counter products is that most consumers are not
knowledgeable or do not bother to read which of these formulations contain
paracetamol. Others patient may not be informed or do not understand the concept of
maximum recommended daily dose, or are not aware of the potential for
hepatotoxicity with excessive dosing, despite the strong warnings and dosing
recommendations in the label or package inserts.
Treatment may include activated charcoal if the person seeks medical help soon after
the overdose. Attempting to force the person to vomit is not recommended. If there is
a potential for toxicity, the antidote acetylcysteine is recommended.