Letters

Effects of legislation restricting pack sizes of paracetamol on self poisoning

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7313.633a (Published 15 September 2001) Cite this as: BMJ 2001;323:633

It's too early to tell yet

  1. Paul Dargan, registrar in toxicology,
  2. Alison Jones, consultant physician (alison.jones@gstt.sthames.nhs.uk)
  1. National Poisons Information Service (London), Guy's and St Thomas's Hospital, London SE14 5ER
  2. Department of Clinical Toxicology, Newcastle Mater Hospital and NSW Poison Information Centre, Newcastle, New South Wales, Australia
  3. Departments of Pediatric Critical Care, Stanford University, School of Medicine, Stanford, CA 94305, USA
  4. Department of Genetics, Stanford University, School of Medicine, Beckman Center B007, Stanford, CA 94305-5318
  5. Vaccine Research Center, National Institutes of Health, MSC 3015, Bethesda, MD 20892-3015, USA

    EDITOR—Any measure that will reduce the incidence of paracetamol poisoning is to be welcomed. Hawton et al report the impact of legislation restricting pack sizes of paracetamol and salicylate on self poisoning,1 but there are major limitations in interpretation—for example, the period studied after the legislation came into force is too short (one year) for its impact to be fully assessed. This is particularly relevant in the assessment of patients with acute liver disease as the numbers are small and there will be baseline variability.2 The data from the liver unit at King's College Hospital cross the line indicating an incidence rate ratio of 1, and the data from Leeds, Newcastle, and the Royal Free Hospital have incidences close to zero.1

    The authors give data on blood paracetamol concentrations and mean number of tablets taken per paracetamol overdose, but these did not greatly change and would be the main determinant of outcome in early paracetamol poisoning.3 Certainly, prothrombin time would not be expected to be a good marker, not least because of the availability of adequate treatment with acetylcysteine.

    Over the same period Donogue et al examined 2020 …

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