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Paracetamol poisoning, also known as acetaminophen toxicity, results when individuals take a single large overdose. It can also occur if the drug is used for long periods, especially if the patient has liver impairment or drinks excessively. Paracetamol is safe in small doses, but in large amounts it can cause profound liver damage and death. This condition is challenging because its best treatment must be initiated within the first 24 hours of the damage occurring, when many patients are asymptomatic. Just as the illness becomes obvious, it grows more difficult to successfully treat.
There are differing reports on the types of behaviors most likely to cause paracetamol poisoning. Intentional or accidental overdose are potential causes. Sometimes people simply exceed the recommended dose a single time, or take it for too long at maximum or above maximum amounts. Alternately, chronic drinking, alcoholism, and use of certain drugs that compromise the liver have been associated with acetaminophen toxicity. The best prevention is to stay within the guidelines for safe use of the drug, paying attention to any contraindications, and to keep the medicine out of reach of children.
All medical writing devoted to paracetamol poisoning stresses the importance of getting quick treatment. This might be easy to do if an overdose is obvious, such as a child’s overdose. It is harder to accomplish in many other circumstances. Many patients with paracetamol poisoning don’t show an immediate reaction. They may remain asymptomatic for a full 24 hours.
When symptoms begin they are described as occurring in four phases. The first phase may have no signs or can include disinterest in eating, vomiting, nausea, and simply feeling sick. As the condition progresses to the second phase, severe pain in the abdomen is likely.
In phase three patients become jaundiced, the liver swells, and clotting or bleeding disorders typically develop. This stage causes fatality for some patients, but if it is survived, the body’s liver gradually resumes normal workings and the symptoms stop. Most of the major disease effects occur within four to five days, though full recovery takes several weeks.
The types of treatment for paracetamol poisoning are best undertaken very early, preferably prior to patients becoming symptomatic. If an overdose has been confirmed and has occurred within the last few hours, patients may be given activated charcoal to induce vomiting. At the same time, n-acetylcysteine (NAC) is also given because this can reduce the liver toxicity. NAC is most helpful within the first 10 hours of overdose, and starts to lose its effectiveness when given later than the first 24 hours. Other types of supportive care could also be offered, including giving fluids or other medications that may protect the liver or promote patient comfort.
When NAC is administered early, it often helps quickly resolve paracetamol poisoning. Patients who don’t receive it in time are much more at risk for severe and life-threatening illness. A few individuals may undergo liver transplantation if the disease progresses undeterred to the third phase, but this option is not open to everyone.