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Overdosage of paracetamol usually involves four phases with the following signs and symptoms: Reduced or loss of appetite, nausea, vomiting, malaise (a general feeling of being unwell), and excessive sweating.
Right upper abdominal pain or tenderness, liver enlargement which may be characterized by abdominal discomfort of "feeling full", elevated bilirubin and liver enzyme concentrations, prolongation of prothrombin time, and occasionally decreased urine output.
Reduced or loss of appetite, nausea, vomiting, and malaise recur (usually 3 to 5 days after initial symptom onset); signs of liver failure (e.g., jaundice, hypoglycemia, coagulopathy, encephalopathy), and possibly kidney failure and cardiomyopathy (disorder of the heart muscle) may develop.
Recovery or progression to fatal complete liver failure.
Metabolic acidosis (excessive acid in the body), encephalopathy (abnormal brain function), coma, and death may also occur. Clinical and laboratory evidence of hepatic toxicity may not be apparent 48 to 72 hours post-ingestion, and reach a maximum after 4 to 6 days.
What to Do When the Patient Has Taken More Than the Recommended Dosage: If the patient has taken more than the recommended dosage, consult a doctor or contact a poison control center right away, even if the patient seems well, as there is a risk of delayed serious liver damage. Quick medical attention is important for adults as well as for children even if the patient does not notice any signs or symptoms.
