Paracetamol is an over-the-counter (OTC), generic pain reliever for adults and children. Overdoses are fairly common occurrences in the West. Symptoms may be absent during the first 24 hours or may include nausea, vomiting, sweating, and pallor. As liver function becomes more compromised, jaundice, confusion, and loss of consciousness and other symptoms are possible. Unless treated, the patient will experience severe symptoms such as organ failure, brain swelling, and, possibly, death.
In the US and UK, paracetamol is sold generically as acetaminophen. Tylenol® and Panadol® are two brand name versions available in some parts of the world. This medication may be purchased in tablet, capsule, liquid, or suppository formulations for adults or children. It may also be administered intravenously or intramuscularly by qualified medical personnel.
Doctors recommend that adults take one or two 500 milligram pills every four to six hours for pain relief. To make sure that one stays well away from a paracetamol overdose, no more than 4000 milligrams should be taken in any 24-hour period. Children's doses are based on body weight at 2 teaspoons per 2.2 pounds (10 milligrams per kilogram) every four to six hours.
Taking more than 7000 milligrams of this medication is likely to result in an overdose. This amount may vary somewhat depending upon the person's overall health and any other medications he is taking. A person in poor health on multiple medications, or someone who is alcoholic, may have an overdose threshold of less than 7000 milligrams.
During the first 12-24 hours following a paracetamol overdose, there may be no symptoms, but some people may experience nausea, vomiting, excessive sweating, and paleness. As the liver metabolizes the paracetamol, other symptoms might appear. These may include jaundice, i.e., yellowing of the skin, abdominal pain, confusion, kidney failure, or loss of consciousness. The final stages of a paracetamol overdose are marked by multiple organ failure, low blood sugar, coagulation problems, sepsis, brain swelling, and death. No matter how much paracetamol someone has taken, he is not likely to die in less than five days.
Once a paracetamol overdose is evidenced, treatment should be started immediately. In the best of all circumstances, this would be within 8-12 hours of the overdose. Treatment must be administered in the hospital. Activated charcoal, gastric lavage, and/or ipecac syrup may be part of the treatment. According to the Cochrane Institute, activated charcoal appears to be the most effective at minimizing absorption of the drug. If someone survives a paracetamol overdose, the liver and other organs will generally heal within several weeks to a few months.