Cases Of Paracetamol Overdose Research Articles

Characteristic of Paracetamol Overdose Before and During COVID-19 Pandemic, Saudi Arabia, 2019-2020

Purpose: Paracetamol is the most used medication worldwide; due to its analgesic and antipyretic effect; it had been included within the recommended regimen for COVID-19 patients. This study aimed at exploring the changes in the incidence of paracetamol overdose during pandemic compared to pre-pandemic periods.
 Methodology: Through a record-based study, all cases of paracetamol overdose who had been reported to the ministry of health in Saudi Arabia in the period between January 2019 and December 2020 were included in the study. Data stored in electronic form were retrieved and analyzed using SPSS version 26. Frequency distribution was used to describe categorical variables.
 Findings: Two hundred and forty four paracetamol overdose cases were reported in 2020 (during the pandemic) compared to 449 in 2019 (pre-pandemic) with dominance of females (62.6%) and Saudis (86.7%). Most cases ingested paracetamol orally mainly in solid forms (76.5%), and they were mostly diagnosed as confirmed cases on admission (84.6%). The great majority recovered and discharged (87.8%). The overall annual incidence of paracetamol in (pre-pandemic) was 1.32/100,000 which dropped markedly during pandemic to 0.71/100,000.
 Conclusion: There was a general decline in the incidence of paracetamol overdose during COVID-19 pandemic, with relative increase in incidence in home incidents and in children.
 Recommendation: Health education to the public to increase their awareness about proper and safe use of paracetamol is highly recommended, as well as introducing instructions and guidelines for practitioners about prescribing it.

Implementation and outcome of an electronic tool for detection of paracetamol overdose in a tertiary care hospital

Background Paracetamol is a widely used analgesic and antipyretic drug in hospitals. The development and implementation of an electronic tool with algorithm-based alerts (e-agent) in a clinical information system could reduce the risk of overdose. Objective In this study, the performance of such an e-agent developed to detect paracetamol overdosing was analyzed. Setting Swiss tertiary care hospital. Method All patients ≥ 18 years old who had documented paracetamol administration in the used clinical information system during 2017 were retrospectively screened for an absolute and relative overdosing of paracetamol (> 4 g and > 60 mg/kg/24 h, respectively). This was compared with the patients for which the e-agent had, during the same period, prospectively made an alert for absolute or relative overdosing or for a dosing interval < 4 h (potentially leading to an absolute overdose). Main outcome measure E-agent performance defined as detection rate. Results of the 13,196 adult patients who received at least one dose of paracetamol, 2292 were exposed at least once to > 4 g/day (17.4%), 39 of these (0.3% of total) were given > 5 g paracetamol. None received more than 6 g. The e-agent detected 87.2% of cases with doses > 5 g. In most cases (87.9%), the cause of the absolute overdose was a switch from intravenous to oral paracetamol, resulting in an absolute overdose the day of the change. The maximal daily dose of 60 mg/kg was exceeded in 30.1% of patients weighing < 50 kg, as well as in 42.3% of patients weighing < 60 kg. The e-agent detected 73.4% and 75.5% of those cases. Multiple absolute overdoses were found in 204 patients. The e-agent detected 72.7% of those. 90 multiple overdoses occurred during the same hospital stay and 11 on consecutive days. Conclusion Paracetamol overdose is a common medication error in hospitalized patients, which may occur due to process failures such as wrong timing when changing administration route or when factors like comedication and low body weight are ignored. The e-agent detects cases of paracetamol overdose, and therefore, can help prevent this kind of medication error in the clinical setting.

Management of paracetamol overdose: current controversies.

Paracetamol (acetaminophen) is one of the most frequently used analgesics, and is the most commonly used substance in self-poisoning in the US and UK. Paracetamol toxicity is manifested primarily in the liver. Treatment with N-acetyl-cysteine (NAC), if started within 10 hours from ingestion, can prevent hepatic damage in most cases. Pharmacokinetic data relating plasma paracetamol concentration to time after ingestion have been used to generate a 'probable hepatoxicity line' to predict which cases of paracetamol overdose will result in hepatotoxicity and should be treated with NAC. However, later studies use a 25% lower line as their 'possible hepatotoxicity line'. Although adopting the original line may save considerable resources, further studies are needed to determine whether such an approach is safe. On the basis of the metabolism of paracetamol, several risk factors for paracetamol toxicity have been proposed. These risk factors include long term alcohol (ethanol) ingestion, fasting and treatment with drugs that induce the cytochrome P450 2E1 enzyme system. Although some studies have suggested that these risk factors may be associated with worse prognosis, the data are inconclusive. However, until further evidence is available, we suggest that the lower line should be used when risk factors are present. In Canada and the UK, the intravenous regimen for NAC is used almost exclusively; in the US, an oral regimen is used. Both regimens have been shown to be effective. There is no large scale study with direct comparison between these 2 therapeutic protocols and controversy still exists as to which regimen is superior. During the last few years there has been an increase in the number of reports of liver failure associated with prolonged paracetamol administration for therapeutic reasons. The true incidence of this phenomenon is not known. We suggest testing liver enzyme levels if a child has received more than 75 mg/kg/day of paracetamol for more than 24 hours during febrile illness, and to treat with NAC when transaminase levels are elevated. Paracetamol overdose during pregnancy should be treated with either oral or intravenous NAC according to the regular protocols in order to prevent maternal, and potentially fetal, toxicity. Unless severe maternal toxicity develops, paracetamol overdose does not appear to increase the risk for adverse pregnancy outcome.

Paracetamol overdosesParacetamol overdoses Fagan E Wannan G Reducing paracetamol overdoses. British Medical Journal. 1996. 313, 1417-1418.

Medicines containing paracetamol are the most common cause of intentional drug overdose in Britain with about 70,000 cases of paracetamol overdose each year. Fortunately, death from overdose is fare - about 200 cases - Against a safety record of 30 million packs containing paracetamol sold each year.

Paracetamol metabolites in the neonate following maternal overdose.

A case of paracetamol overdose in a 36 week pregnant woman is described. The baby was delivered by Caesarian section 6 h after the overdose. The mother but not the baby was treated with N-acetylcysteine and neither suffered liver damage. The plasma paracetamol half-life was prolonged to 10 h in the neonate compared to 2.5 h in the mother and was unaffected by a two volume exchange transfusion. The pattern of urinary metabolites in the neonate was similar to that observed in the mother, but there was a marked delay in the time taken to reach peak plasma concentrations of metabolites. This is consistent with a very slow biotransformation of the drug and may explain the relative resistance of very young children to the hepatotoxicity of paracetamol. There was no evidence of limited or decreasing capacity in sulphate conjugation nor was sulphation the major metabolic pathway. In retrospect both the obstetrical intervention and the exchange transfusion were unnecessary.

Paracetamol overdose: a plan of management.

Four cases of paracetamol overdose are described. The rationale for the use of dimercaprol, a sulphydryl-containing compound, as a specific antidote is discussed with reference to the pharmacodynamics of paracetamol. A recommended plan of management is presented.