Everyone Healthy Library
Acetaminophen Poisoning
Also Known As: Paracetamol Poisoning
Condition / disease reference page from the Everyone Healthy database.
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Connected health information
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Condition overview
Attributes
Incidenceis approximately 1 in 871 people
Linked signs and symptoms
20Each sign/symptom opens its own page and links back to related conditions.
- Abdominal Tenderness
- Appetite Loss (Anorexia)
- Blood Glucose Levels Low or Decreased (Hypoglycaemia, Hypoglycemia)
- Blood Transaminase Raised in Liver
- Cardiomyopathy
- Coma
- Diaphoresis (Increased Perspiration/Sweating)
- Hepatotoxicity
- Kidney (Renal) Impairment
- Liver Enlarged Or Tender
- Metabolic Acidosis
- Mind: Confusion
- Mind: Malaise
- Nausea
- Pain Abdominal
- Pain Right Upper Quadrant
- Skin Yellowing (Jaundice)
- Skin: Pale, Lack of Colour (Pallid Complexion)
- Sweating (Perspiring)
- Vomiting
Linked drugs / medications
1Medication information is educational only. A doctor or pharmacist should advise whether any medicine is appropriate.
Treatments, therapies and supportive options
10Grouped by treatment type. These are educational database links, not personal treatment recommendations. Evidence labels are shown only where stored in the EH database.
Surgery
1Medical therapy
2Lifestyle changes
1Behavioural changes
2Counselling and support
3Linked diagnostic tests and investigations
6These are pulled from both EH diagnostic-test link tables, including the older large test-link table.
Biological markers/agents
2This visual map shows biological markers/agents reported as increased or decreased with this condition. These are educational relationships only; test results must be interpreted by a qualified clinician because ranges vary by lab, method, age, sex and clinical context.
Often increased
2- EosinophilsReference range exampleAdult ( > 16y): 0–3 %; 0–3 %Linked diagnostic testsDifferential White Blood Cell Count Tests, Eosinophil Differential Of Total WBC
- Segmented NeutrophilsReference range exampleAdult ( > 16y): 50–62 %; Adult ( > 16y): 2,500–8,000 mm3Linked diagnostic testsDifferential White Blood Cell Count Tests, Neutrophil Absolute Count
Often decreased
0No markers in this group.
Introduction / full article
Acetaminophen Poisoning
Acetaminophen (Paracetamol) Poisoning
Acetaminophen poisoning (also called paracetamol toxicity) is due to excessive use of the pharmaceutical analgesic drug paracetamol, known as acetaminophen in the United States. Damage to the liver (hepatotoxicity) is the main effect, and it is consequently the most common cause of acute hepatic failure in many areas of the world.
The toxic dose of paracetamol varies between individuals. For adults, single doses in excess of 10g or 200mg/kg of body weight – whichever is lower – are likely sufficient to cause toxicity.
Causes
Certain factors have the potential to increase the risk of developing acetaminophen poisoning. These include:
- Frequent heavy alcohol consumption;
- Fasting; and
- Simultaneous, large doses of paracetamol and caffeine.
Symptoms and diagnosis
Signs of acetaminophen poisoning appear in stages. The first occurs within hours of overdose, and is characterised by nausea, vomiting and paleness. In severe cases, patients may lose consciousness and fall into coma.
Several days after ingestion, symptoms indicating increased liver damage will appear, such as:
- Right upper-quadrant pain (signalling necrosis of cells in the liver);
- Jaundice;
- Hepatic encephalopathy (severely depressed level of consciousness due to liver damage); and
- Multiple organ failure.
The most effective method of diagnosis involves testing the paracetamol concentration in the drug. This process is usually taken at least four hours following ingestion, to prevent any underestimation due to unabsorbed paracetamol still in the gastrointestinal tract.
Treatment
Gastric decontamination is usually the first form of treatment for acetaminophen poisoning, involving the administration of activated charcoal to absorb paracetamol from the gastrointestinal tract. This is most effective if performed within two hours of ingestion, during which the natural process of paracetamol absorption into the bloodstream occurs.
Alternatively, gastric lavage – more commonly known as stomach pumping – may be considered for considerably larger doses.
For patients suffering, or expected to die from, hepatic failure, a liver transplantation may also be recommended.