Severity of overdose after restriction of paracetamol availability

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7285.553 (Published 03 March 2001) Cite this as: BMJ 2001;322:553

Study's results conflict with those of other papers

  1. C L Sheen (chris@memo.dundee.ac.uk), clinical research fellow,
  2. T M MacDonald, professor of pharmacology and pharmacoepidemiology
  1. Medicines Monitoring Unit, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY
  2. Department of Medicine, Withybush General Hospital, Pembrokeshire SA61 2PZ
  3. Faculty of Business, Auckland University of Technology, Private Bag 92006, Auckland 1, New Zealand

    EDITOR—Robinson et al report a reduction in the amount of paracetamol ingested in overdose since the introduction of reduced pack sizes and blister packing of over the counter paracetamol in September 1998.1 They found no change, however, in the incidence of hepatotoxicity. Their results contrast with those of other studies, which have shown a 21% reduction in episodes of hepatotoxicity and a 64% reduction in the development of severe hepatotoxicity. 2 3

    As they have stated, hepatic failure is rare if <12 g of paracetamol is ingested.4 But the median dose ingested in their study did not reach this level. It is thus unsurprising that the study included only five cases of hepatotoxicity; given this low number, it seems imprudent to claim that no change in incidence has occurred.

    In addition, the paracetamol concentrations quoted in the paper are low, considering that concentrations >200 mg/l four hours after ingestion and >130 mg/l six hours after ingestion are used to guide the appropriate use of acetylcysteine treatment. Despite the low concentrations quoted, acetylcysteine was given to 25% and 31% …

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