Overview
Acetaminophen overdose is a serious and potentially fatal condition that occurs when a person takes more than the recommended dose of acetaminophen (also known as paracetamol). While this medication is commonly used for pain relief and fever reduction, excessive intake—whether accidental or intentional—can cause severe liver damage within hours to days. Early recognition and treatment are essential to prevent life-threatening complications.
What is Acetaminophen Overdose?
Acetaminophen overdose happens when the body receives more acetaminophen than the liver can safely process. The excess drug gets converted into a toxic compound (NAPQI) that damages liver cells. Even a single large dose or multiple smaller doses over time can lead to liver failure. It is one of the most common causes of acute liver failure worldwide.
Symptoms
Early Symptoms (within the first 24 hours):
- Nausea and vomiting
- Loss of appetite
- Sweating
- Fatigue or weakness
- Pale skin
- Abdominal pain (especially in the upper right side)
Intermediate Symptoms (24 to 72 hours):
- Worsening abdominal pain
- Liver tenderness
- Dark urine
- Jaundice (yellowing of skin or eyes)
Late Symptoms (72 to 96 hours):
- Confusion
- Bleeding (due to liver failure)
- Seizures
- Coma
- Multi-organ failure
- Death (in severe, untreated cases)
Causes
- Accidental Overdose: Taking more than the recommended dosage, especially with combination medications.
- Chronic Overdose: Repeated doses exceeding daily limits, often in people with ongoing pain.
- Intentional Overdose: In cases of self-harm or suicide attempts.
- Mixing Products: Many cold and flu medications contain acetaminophen, leading to unintentional overdose.
- Alcohol Use: Alcohol increases the liver’s susceptibility to acetaminophen toxicity.
Risk Factors
- Taking more than 4,000 mg of acetaminophen in 24 hours
- Combining multiple medications that contain acetaminophen
- Chronic alcohol use or liver disease
- Fasting or malnutrition (which lowers liver detox capacity)
- Age extremes (very young or elderly)
- Use of enzyme-inducing medications (e.g., rifampin, phenytoin)
Complications
- Acute liver failure
- Permanent liver damage or cirrhosis
- Hepatic encephalopathy (brain dysfunction due to liver failure)
- Internal bleeding
- Death (if untreated)
Even with treatment, severe cases may require a liver transplant.
Prevention
- Follow dosing instructions strictly: Adults should not exceed 4,000 mg/day unless directed by a doctor.
- Check medication labels: Avoid taking multiple drugs that contain acetaminophen.
- Avoid alcohol while using acetaminophen.
- Use pediatric formulations properly in children based on weight.
- Store medications safely to prevent accidental ingestion by children.
- Educate patients and caregivers about the risks of overuse.
Treatment Options in korea
Immediate Medical Attention Is Critical.
If within 1–2 hours of ingestion:
- Activated charcoal may be given to absorb the drug in the stomach.
Main Antidote:
- N-acetylcysteine (NAC): This medication replenishes glutathione, a substance that detoxifies the harmful metabolite NAPQI.
- Most effective within 8–10 hours of overdose.
- Can be administered orally or intravenously.
Additional Treatment Measures:
- Intravenous fluids
- Liver function monitoring
- Hospitalization for severe cases
- Intensive care for liver failure
- Liver transplant if liver damage is irreversible
