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The risk of paracetamol toxicity is increased in elderly and pediatric patients, in patients with hepatic insufficiency, chronic alcoholism, present nutritional dystrophy, and reduced enzyme activity. Overdosing may be fatal in these cases.
Symptoms generally become apparent within the first 24 hours and comprise nausea, vomiting, anorexia, pallor, abdominal pain.
Overdose may occur after a single administration of 7.5 g or more of paracetamol in adults and a single administration of 140 mg/kg of body weight in children. It causes hepatic cytolysis, hepatic insufficiency, metabolic acidosis, encephalopathy which may result in coma and death. Levels of hepatic transaminases (AST, ALT), lactate dehydrogenase and bilirubin may increase, and levels of prothrombin may reduce within 12 to 48 hours after administration.
Clinical symptoms of liver damage generally become evident 2 days after, and reach a maximum after 4 to 6 days.
Treatment: Administration of sulphydryl-group donors and precursors of glutathione-methionine synthesis in 8-9 hours after the overdose, and administration of N-acetylcysteine after 10 hours. The decision to perform additional therapeutic measures (further administration of methionine, intravenous administration of N-acetylcysteine) should be made based on serum concentration of paracetamol and the time that has passed since the overdose.
