Paracetamol overdose

Paracetamol, known as acetaminophen in North America, is one of the most widely used over-the-counter analgesics and antipyretics. While it is generally safe at therapeutic doses, paracetamol overdose is a common and potentially fatal occurrence, leading to significant morbidity and mortality if not promptly identified and managed. It is the leading cause of acute liver failure in the Western world, prompting urgent attention in emergency medicine and primary care settings.

The management of paracetamol overdose is a critical skill for healthcare professionals. Key to this management is the early recognition of overdose, accurate assessment of the ingested dose, and understanding of the risk factors that could predispose to greater harm. The timely administration of the antidote, N-Acetylcysteine (NAC), within an 8-hour window post-ingestion, plays a vital role in preventing serious outcomes by replenishing intracellular glutathione reserves, essential for detoxifying the harmful metabolites of paracetamol.

Staggered overdoses, where the drug is taken over a period, present unique challenges and may not present with clear signs and symptoms until the hepatic injury has occurred. This necessitates a high index of suspicion and a thorough history-taking and clinical assessment. This introduction sets the stage for discussing the clinical approach to managing paracetamol...