Liver unit admission following paracetamol overdose with concentrations below current UK treatment thresholds (2007)

Author(s): Beer C, Pakravan K, Hudson M, Smith LT, Simpson K, Bateman DN, Thomas SHL

    Abstract: Background: It has been suggested that current United Kingdom thresholds for treating paracetamol overdose should be reduced, following case reports of patients developing fatal liver failure having presented with paracetamol concentrations below these thresholds. Aim. To determine the frequency of severe liver dysfunction following paracetamol overdose when paracetamol concentrations are below current UK antidote thresholds Design: Retrospective case note review. Methods: Details were collected from all patients admitted to liver transplant units in Newcastle and Edinburgh with paracetamol-induced hepatotoxicity. Results: Of 696 patients admitted to the two liver units following paracetamol overdose, 14 presented between 4 and 15 h after overdose with paracetamol concentrations below current UK treatment thresholds (estimated annual population rate 0.15 / million person years). Over the period of study > 100,000 presentations with paracetamol overdose would be expected in the catchment populations for these liver units. Conclusions: In view of the rarity of this event, this research does not suggest a need to lower current thresholds for antidotal treatment.

      • Date: 20-01-2007
      • Journal: Quarterly Journal of Medicine
      • Volume: 100
      • Issue: 2
      • Pages: 93-96
      • Publisher: Oxford University Press
      • Publication type: Article
      • Bibliographic status: Published

      Professor Simon Thomas
      Prof of Clin Pharmacology & Therapeutics