Paracetamol Overdose in the Postoperative Postpartum Period

Abstract

Paracetamol is the most commonly used medication for pain and fever worldwide and is readily available over the counter. The recommended maximum daily dose for an adult is three to four-gram. Paracetamol poisoning is the foremost cause of acute liver failure in the Western world and accounts for the highest percentage of drug overdose worldwide. Paracetamol administered in therapeutic doses is mainly conjugated with sulfate and glucuronide to form non-toxic metabolites via phase II metabolism. A small portion is metabolized to N-acetyl-p-benzoquinoneimine (NAPQI), a toxic metabolite. NAPQI is conjugated with glutathione and detoxified to form cysteine and mercapturic acid conjugates in normal circumstances. However, under certain conditions, NAPQI is not effectively detoxified due to depleting glutathione, causing hepatocellular necrosis and subsequently, liver failure. We present a case involving paracetamol overdose in a 35-year-old female who self-medicated on a large number of paracetamol pills daily for two weeks because of postoperative pain. This resulted in deranged liver enzymes. N-acetylcysteine was administered and led to clinical improvement and normalized LFTs. The case highlights patients’ ignorance of the dangers of paracetamol overdose and the importance of N-acetylcysteine in its management.