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Acetaminophen (Paracetamol) Poisoning

Paracetamol overdose may be silent at first but can progress to severe liver failure within 24-72 hours.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Acil Servis department. Book Appointment →

What is Acetaminophen (Paracetamol) Poisoning?

Acetaminophen (paracetamol) is the most widely used over-the-counter antipyretic and analgesic; it is safe at therapeutic doses but causes liver toxicity in overdose. In adults, a single intake >150 mg/kg or >7.5 g is considered toxic.

Its toxic metabolite NAPQI causes centrilobular necrosis in hepatocytes through glutathione depletion. The clinical picture may be silent at first; liver enzymes rise within 24-72 hours, and acute liver failure may develop on days 3-5.

The mainstay of treatment is the antidote N-acetylcysteine (NAC); when started within the first 8-10 hours, it largely prevents hepatotoxicity. The Rumack-Matthew nomogram provides risk assessment based on serum levels after the 4th hour.

Symptoms

First 24 hours: nausea, vomiting, anorexia, malaise (mild picture)
24-72 hours: right upper quadrant pain and elevated liver enzymes
72-96 hours: jaundice, bleeding tendency, encephalopathy
In advanced stages: coagulopathy, hypoglycemia, and acidosis
Acute renal failure (in some cases)
Confusion and coma (fulminant failure)

Risk Factors

High single dose (>150 mg/kg) or repeated supratherapeutic intake
Chronic alcohol use and liver disease
Fasting and malnutrition (low glutathione)
Suicide attempt or unintentional multiple-product (cold medication) intake
Use of liver enzyme-inducing drugs
Unintentional high-dose intake in young children

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Call emergency services immediately for any suspected paracetamol overdose
  • Even if the patient is asymptomatic, they should go to the emergency department
  • Activated charcoal may be beneficial in the first 1-2 hours
  • If coagulopathy, encephalopathy, or acidosis is present, the patient should be referred to a transplant center

Treatment Methods

01
Emergency hospital transport and serum paracetamol level at 4 hours
02
Risk assessment according to the Rumack-Matthew nomogram
03
Intravenous or oral N-acetylcysteine protocol
04
Supportive treatment: fluids, electrolytes, hypoglycemia control
05
Transplant evaluation by King's College criteria in fulminant failure
06
Psychiatric evaluation (in intentional intakes)

Which Department to Visit?

You can visit our Acil Servis department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.