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There is a risk of poisoning, particularly in elderly subjects, in patients with liver disease, in cases of chronic alcoholism, in patient with chronic malnutrition and in patients receiving enzyme inducers. Overdosing may be fatal in these cases. Symptoms generally appear within the first 24 hrs and comprise: Nausea, vomiting, anorexia, pallor and abdominal pain. Overdose, paracetamol ≥7.5 g in adults or 140 mg/kg body weight in children in a single administration, causes hepatic cytolysis likely to induce complete and irreversible necrosis, resulting in hepatocellular insufficiency, metabolic acidosis and encephalopathy which may lead to coma and death. Simultaneously, increased levels of hepatic transaminases [aspartate aminotransferase (AST), alanine aminotransferase (ALT)], lactate dehydrogenase and bilirubin are observed together with decreased prothrombin levels that may appear 12-48 hrs after administration. Clinical symptoms of liver damage are usually evident after 2 days.
Treatment: Immediate hospitalization.
Before beginning treatment, take blood sample for plasma paracetamol assay, as soon as possible after overdose. The treatment includes administration of the antidote, N-acetylcysteine (NAC) by IV or oral route if possible before the 10th hr. N-acetylcysteine can, however, give some degree of protection even after 10 hrs but in these cases, prolonged treatment is given.
Symptomatic Treatment: Hepatic test must be carried out at the beginning of treatment and repeated every 24 hrs. In most cases, hepatic transaminases return into normal in 1-2 weeks with full return of normal liver function. In very severe cases, however, liver transplantation may be necessary.
