Paracetamol warning

[Sergeant Pluck]

A sobering tale:

http://news.bbc.co.uk/1/hi/northern_ireland/foyle_and_west/7501913.stm

It's not much more than the recommended dose: max 8 x 500 mg per 24 hours. Half a tablet more in fact, although she may obviously have taken them in less than 48 hours.

[Maladict]

Just a guess, but did the inquest say anything about how much of a drinker she was?

[Mrs Pingu]

It's very easy to accidentally overdose apparently. This is why paracetamol should be dumped in favour for the one that comes with the antidote formulated in it. It's more expensive now but if they swapped the twot here wouldn't be much difference in price.

[TimO]

There's more information in this Belfast Telegraph article.  Nowhere does it seem to give a specific reason why she suffered from an OD, and since she worked in a "chemist’s shop" (ie Pharmacy), it seems unlikely that she would have done anything daft.

At least one newspaper has it phrased that she died because she took half a paracetamol too many, which is clearly nonsense.

I'd assume that there is some slack in the maximum dose, but that occasionally someone will be particularly sensitive to the drug for one reason or another, and even what appears to be a safe dose (or so little over as to be damn near the same thing) can cause problems.

[Sergeant Pluck]

Just a guess, but did the inquest say anything about how much of a drinker she was?

There is no mention of this. She worked in a chemists' shop. I agree that there could, of course, have been some pre-existing liver condition but I think the reports would have mentioned it.

Personally I think it is more likely that she inadvertently took more than was stated. They do seem to be very precise on the "16 and a half" but I've no idea if that figure is derived from a biochemical marker of some kind or if it is based on her own account.

In general I think the line between recommended dose and lethal dose could not possibly be so fine, but it seems there are those who are more vulnerable than others.

The biggest danger lies in taking paracetamol in combination with other pain killers without being aware that the others may also have paracetamol.

A very very nasty way to die.

[Edit: cross post with TimO]

[LindaG]

Why on earth would a young healthy person take half a paracetamol?

[Sergeant Pluck]

Why on earth would a young healthy person take half a paracetamol?

Don't know. I do suspect that you have identified the problem though! The effective dose is one gram. Taking one 500 mg tablet is not an adequate dose to do anything in an adult, nver mind half that. If she was fiddling about with ineffective doses it would be very easy to lose track of what was ingested. It seems she was also aware, when seeking treatment, that she had overdosed.

There is also no mention of the timescale: she took them "over two days" but in fact that could have been within 24 hours or less.

Still, though. A safe drug but with unfortunate consequences for  a few.

[Mrs Pingu]

Just because she had 16.5 tablets in 48 hours, doesn't mean she didn't have say, 10 of them in 24 hours. (i.e.12g/day) I think in some cases it really is that simple. Toxicity will differ in the individual and then be changed by other factors such as chronic alcohol consumption, or even just a hangover.
This could be affected by something like Night Nurse, which contains alcohol as well paracetamol.

[TimO]

Reading the Wikipedia entry on Paracetamol, it suggests that acute renal failure is rare, and the peak in mortality is at something like four days.  With my very limited medical knowledge, it still sounds like either something else was going on (possibly not reported) or she was unfortunately very susceptible to an OD.  This sounds like a very marginal amount over the generally suggested limit, and things seem to have happened very rapidly and more severely than would happen even with a much higher dose (assuming Wikipedia is accurate, which I realise may well not be the case).

It does indeed sound like a horrible way to die, as I understand it, people start to feel better (which seems to have happened in this case) and think they've got over it, before things suddenly nose dive and get much worse.

[Mrs Pingu]

Why on earth would a young healthy person take half a paracetamol?

I dunno but I wish I could figure out who the little bastard is who keeps helping themselves to 1 bloody tablet from my stash at work!
(It's well known that I've got a stash in my drawer which I'm happy for people to have but I wish they'd stop taking 1 frikkin' tablet - especially when I've got a headache!)

[Mrs Pingu]

TimO, I think the four days is referring to time after OD ingestion, not days of administration. There's no mention of time to death in the BBC article.

[Sergeant Pluck]

It's the liver that is most susceptible.

Yes, I have looked after people in A&E that have taken deliberate overdoses, and indeed on transfer up to the ward they have been fine. A few days later though... it becomes clear the liver is irreversibly on the way out, while in the meantime they have, sometimes, got over their acute crisis that drove them to OD. But it's too late. Very sad.

Interesting stuff on Wikipedia about variations in the ability to metabolise the drug.

[Jaded]

Yes - that's what we were taught.

You come round from the overdose then have four more days. You don't feel too bad but there's nothing that can be done unless there happens to be a matching liver there.

[TimO]

There are some dates in the Belfast Telegraph article, but I must have misread something, since I thought she died only a couple of days after she took the pills, but reading it again, it says that she took the pills on the 19th and 20th, and died on the 25th, which is actually consistent with some of the details in the Wikipedia entry.

It still seems that she was very unlucky, but it will however make me even more paranoid about using paracetamol.

Paracetamol is clearly fairly iffy from an OD point of view, Aspirin is I think harder to OD on, but can cause problem if you've got stomach ulcers, does anyone know how dodgy is Ibuprofen is?  It seems to be the least problematic of the easily available analgesics.

[Maladict]

Ibuprofen has the same problem as Aspirin of potentially causing stomach bleeds (which can be fatal).

Personally I avoid the lot as much as possible.  I've not taken any painkillers by mouth since about 8 years ago, save for after hernia repair surgery.

[Mrs Pingu]

Ibrupofen is an NSAID, and from what little I remember from uni (I'm a chemist, not a pharmacist dammit!) they are fine for short term use, but NSAID's can cause their own problems during chronic use.
It certainly explained a few things to me - my Dad had been prescribed large doses of Ibrupofen for dodgy knees, after a year or two's daily use of this he was getting terrible headaches and awful toothache. When he went to the dentist he was told that the tooth causing the problem had no root! When he had to go into hospital a few months on for an operation and stopped the ibrupofen he felt so much better.

So fine for short term use, but different for chronic use.

[Thor]

It's the liver that is most susceptible.

Yes, I have looked after people in A&E that have taken deliberate overdoses, and indeed on transfer up to the ward they have been fine. A few days later though... it becomes clear the liver is irreversibly on the way out, while in the meantime they have, sometimes, got over their acute crisis that drove them to OD. But it's too late. Very sad.

Interesting stuff on Wikipedia about variations in the ability to metabolise the drug.

My father worked for many years in a hospital laboratory. He lamented the frequency with which teenage girls (the most common case) arrived in A&E having taken a paracetamol overdose.  Typically, they were seeking attention for an emotional crisis they had undergone and had taken what they thought was a relatively harmless medication, not realising that they had, in fact, destroyed their liver. 

I don't think the warnings on the packets are sufficient.  Paracetamol can be very dangerous.

[Sergeant Pluck]

My father worked for many years in a hospital laboratory. He lamented the frequency with which teenage girls (the most common case) arrived in A&E having taken a paracetamol overdose.  Typically, they were seeking attention for an emotional crisis they had undergone and had taken what they thought was a relatively harmless medication, not realising that they had, in fact, destroyed their liver. 

I couldn't have summed it up any better. Almost always troubled young souls who have no real intent to end their lives.

[rogerzilla]

On the other hand, it's the only one of the three regular painkillers you can take whern pregnant.

[Thor]

On the other hand, it's the only one of the three regular painkillers you can take whern pregnant.

Or if you're also taking an anticoagulant med, such as Warfarin.

[Fixedwheelnut]

 I think one of the misconceptions I have pulled people up on is taking Paracetomol and then drinking a Lemsip at the same time 
 I always read the label and leaflets even if the Doctor prescribed it.


 One of my daughters was put on painkiller/anti-immflamatories for a long term period of four months and we had to alternate between Calpol [Paracetomol] and Nurofen [Ibuprofen] for each four hourly dose to avoid or reduce the risk of OD.

[TheLurker]

 I have vague (very _very_ vague) memories of a lecture where metacetamol was discussed as an alternative to paracetamol.  Same pain-killing effect, but without the risk of liver damage. Unfortunately the meta form is is/was about 3 farthings a gross more expensive to make so we get the para form.

I expect someone who's a little more up to date on these things than I am will be along soon to correct me...

[tiermat]

It's very easy to accidentally overdose apparently. This is why paracetamol should be dumped in favour for the one that comes with the antidote formulated in it. It's more expensive now but if they swapped the twot here wouldn't be much difference in price.

This is the case in Canada, where it is not possible to buy paracetomol in stores that do not contain an active ingredient that will induce vomiting if you take too many, quite how that works if you take too many over a long time period, I don't know, but apparently it is very effective for the "cry for help" types of ODs.  the extra cost is minimal, apparently.