Death more likely from paracetamol build-up than single overdose
Baku, November 24 (AZERTAC). People who cumulatively take slightly too much paracetamol have a greater risk of death than people who take a single overdose, according to the authors of a study published today (23 November 2011). The Royal Pharmaceutical Society says the findings reinforce the message that, although paracetamol is a safe drug, it can be harmful if the dosage instructions are ignored. Roger Knaggs, spokesperson on pain management for the Society, said: "The message is clear: if you take more paracetamol than is recommended, you won`t improve your pain control, but you may seriously damage your health." Researchers at the University of Edinburgh and the Scottish Liver Transplantation Unit analysed data from 663 patients admitted to the Royal Infirmary of Edinburgh between 1992 and 2008 with paracetamol-induced liver injury. Staggered overdoses accounted for admissions by 161 patients, who had taken paracetamol to relieve abdominal and muscular pains, headache and toothache. Study author Kenneth Simpson, of the University of Edinburgh, said: "On admission, these staggered overdose patients were more likely to have liver and brain problems, require kidney dialysis or help with breathing and were at a greater risk of dying than people who had taken single overdoses" (37.3 per cent versus 27.8 per cent; P=0.025).
However, compared with those who had taken a single overdose, staggered overdose patients included in the study had lower admission serum paracetamol levels (37.8mg/L versus 75.6mg/L; P<0.001) and ingested lower amounts of paracetamol (24g versus 27g; P=0.017). Because paracetamol serum levels provide a poor assessment of toxicity in cases where a patient has taken a staggered overdose — these individuals may have low levels of paracetamol in their blood despite being at high risk of liver failure and death — the study authors recommend that such patients be closely monitored. They should also be considered for the paracetamol antidote N-acetylcysteine, irrespective of serum paracetamol levels. The research, published in the British Journal of Clinical Pharmacology, also reveals that delayed presentation to medical services following an overdose (more than 24 hours) was associated with an increased risk of death and liver transplants (odds ratio 2.25, 95 per cent confidence interval 1.23-4.12; P=0.009). Professor Knaggs, advanced pharmacy practitioner in pain management at Nottingham University Hospitals NHS Trust, said: "If people experience pain and paracetamol doesn`t help, rather than thinking a "top-up" dose may work, they should consult their pharmacist for alternative pain control or referral to someone who can help with the cause of the pain." People should also be reminded to take care with combination cold and influenza.
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