Paracetamol overdose is so rare in India that adding methionine would be wrong

Editor—Krenzelok is perhaps right about N-acetylcysteine and methionine not being universally available in developing nations.1 But we do not agree with his “ethical” suggestion that methionine should be added to paracetamol tablets in developing countries and its use encouraged. Paracetamol overdose is rare in India. Adding methionine would be medically inappropriate and the additional financial burden unjustified.

We studied the records of 68 adults and children admitted to three major hospitals with poisoning or drug overdoses over six months in 1996 in Pune. Pune is a city in western India of about 4 million people. We did not come across a single case of paracetamol overdose. We also interviewed 27 physicians and paediatricians working in acute care in five major hospitals. None had seen a case of paracetamol overdose in the previous year. One physician recalled seeing two cases, and another recalled seeing six over 12 years. According to the paediatricians, kerosene poisoning was the commonest poisoning in children. Organophosphorus poisoning due to a bed bug killer was the commonest in adults. These data suggest that paracetamol overdose is rare in Pune. We do not believe that our city is different from the rest of India. Unfortunately, we do not have a registry of overdoses in Pune and are unable to …