Paracetamol overdose

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Key message

The key message for mental health services is treat all reported paracetamol overdoses as a potential emergency. All actual or suspected paracetamol overdoses should be referred to hospital (Accident & Emergency) for assessment, including blood tests.

Due to the ease of access paracetamol is frequently used in overdose in self-harm attempts. Paracetamol is both acutely and accumulatively toxic. Toxic doses of paracetamol may cause severe hepatocellular necrosis which may ultimately be fatal. Liver damage is maximal 3 – 4 days after paracetamol overdose. Therefore, even if there are no significant early symptoms, patients who report taking a paracetamol overdose should be transferred to an acute hospital urgently.

For CPNs

When a CPN takes someone with a suspected overdose of paracetamol to the emergency department they should have a handover discussion with the receiving service, indicating what the follow up management should be if the person is deemed medically fit, including psychiatric hospital admission.

Toxbase

The following advice is taken from the Toxbase entry for paracetamol:

‘All patients ingesting paracetamol in the context of self-harm should be referred to hospital for assessment, including blood tests (irrespective of reported dose).

All patients who are symptomatic should be referred to hospital for medical assessment, including blood tests.

A single acute overdose of less than 1 hour: Patients ingesting 75 mg/kg or more should be referred directly to hospital for medical assessment, including blood tests.

MHRA advice is that ALL patients require medical assessment, including blood tests, if:

  • they have taken a staggered paracetamol overdose (doses taken over more than one hour);
  • they have taken therapeutic excess (defined as more than a licensed dose for that individual AND more than or equal to 75 mg/kg in any 24-hour period);
  • the time of ingestion is uncertain AND the dose is more than or equal to 75 mg/kg.’

For a 60kg individual 75mg/kg equates to 9 tablets.

Editorial Information

Last reviewed: 31 May 2019

Next review: 01 September 2020

Author(s): MHS Safer Use of Medicines group

Version: V1

Approved By: PMG-MH

Reviewer Name(s): Andrew Walker, Suzanne Burke