Letters p 1654

Paracetamol is an effective, simple analgesic that is well tolerated by adults and children at therapeutic doses. In many countries it is available without prescription. Unfortunately, its ready availability is associated with episodes of poisoning that prompt 3.3% of inquiries to US regional poisons centres,1 10% of inquiries to the UK National Poisons Information Service,2 and up to 43% of all admissions to hospital with self poisoning in the United Kingdom.3 In the United States paracetamol alone accounted for 4.1% of deaths from poisoning reported to American poisons centres in 1997.1 Most deaths are associated with deliberate self poisoning, but therapeutic misadventures do occur rarely, in both adults and children.

In a recent lesson of the week Bridger et al, on the basis of four cases, advocated instigating treatment for paracetamol poisoning at levels below the normal “treatment line” of paracetamol concentrations at four and 15 hours advised in the current guidelines on paracetamol poisoning issued by the UK National Poisons Information Service.4 This paper has generated considerable debate, which is reflected in this week's letters columns (p 1654).5 Is it time to revise the guidelines?

The paper by Bridger et al was inappropriately entitled “Deaths from low dose paracetamol …