Paracetamol is a widely available over-the-counter analgesic, which is frequently taken in overdose. It has some prostaglandin synthesis inhibitory actions. In overdose NSAIDs, which also inhibit prostaglandin synthesis, can cause dose-dependent hypokalaemia, increase fractional excretion of potassium and sodium retention due to renal vasoconstriction. Therapeutic doses of Paracetamol have no effect on potassium levels or excretion. The aim of this study was to study electrolyte changes in patients with Paracetamol overdose. The study was retrospective, conducted on 60 patients with Paracetamol overdose aged 16-65y admitted to the toxicology ward of the Royal Infirmary of Edinburgh from 2000-2003. We excluded the effect of other drugs known to be nephrotoxic by history. The hospital laboratory system was used to extract biochemistry results taken at admission (4-6 hours after ingestion), and again approximately 18 hours later. Changes in electrolytes were correlated to admission Paracetamol levels. The results showed a significant negative correlation between admission Paracetamol level (4-6 hr level) and fall in serum potassium: serum K+ change (y= –0.0021x + 0.0051, r2 = 0.19, P< 0.01). There was no change in serum sodium or creatinine. The mean fall in serum K+ in the quartile with highest Paracetamol concentrations (mean 256 mg/l) was –0.65 ± 0.16 mmol/l. In conclusion, Paracetamol overdose is associated with hypokalaemia in proportion to the dose ingested, suggesting a specific renal effect of Paracetamol in overdose. These findings could be consistent with increasing aldosterone action on the distal tubules as renal perfusion falls due to Paracetamol-induced renal vasoconstriction.  

Acetaminophen is one of the most important antipyretic and analgesic drugs. It has an excellent efficacy when it is used in therapeutic doses, but in unsafe doses it can be resulted in hepatotoxicity and permanent liver failure. Due to disparities that have been reported between the actual and stated concentration of acetaminophen tablets, we aimed to compare the actual quantity of 8 Iranian generic acetaminophen tablets with the stated amount on the label, using HPLC method. Drug concentration has been measured by HPLC. We performed USP procedure for all models such as tablets, capsule, and oral solution assay preparations USP-36 NF31 by standard preparations. Method validation was achieved. For USP guidelines performance we need to concern on standard references. By chromatography equipment, we used HPLC analyzer 1200 degasser, 1200 bin pump, 1200 ALS, and 1200 VWD. Acetaminophen sample solution included 325 mg weighted quantity of the powder that transferred to a 200 ml volumetric flask in addition to 100 ml of mobile phase. A part of this solution was transferred throughout a 0. 5 micrometer permeable filter (or finer). By injecting 10 μ L of standard solution into the chromatograph, major peaks are measured as a response. As a final point, calculation of the quantity of acetaminophen in each brand was obtained via specific formula. According to the USP, all brands consisted of 90. 0– 110. 0 % of the labeled amount of active ingredient (p<0. 05). Consequently, The USP standards are met for drugs with different lot numbers by a variety of companies. The differences of clinical attributes of Paracetamol overdose between Iran and other countries may be related to pharmacokinetic and pharmacodynamics issues, metabolism, genetic factors or environmental effects. Further studies are recommended.

There are hundred thousands of deaths per annum from poisoning in the World. Accidental poisoning is most common in children and over 50 years old persons, but deliberate self-harm becomes predominant in teenage years and early adulthood. Understanding the patterns of poisoning can assist in developing suicide prevention strategies and reducing the risks of accidental poisoning. On the other hand, this could be helpful in reducing the accidental and occupational poisoning cases. In some circumstances, many of these materials can potentially induce poisoning. In excessive amounts, chemicals that are usually harmless, even apparently safe drugs can cause poisoning. To reduce the morbidity and mortality and overall burden of poisoning in the community, consideration should be given to developing education program as an effective tool and establishing poison information centers.

Introduction: Supratherapeutic Paracetamol ingestion in children is an important public health issue, which can result in acute liver failure and death. This may occur as a result of intentional or unintentional single overdose or recurrent, supratherapeutic overdose with therapeutic intent. The objective of this study was to describe the demographics, nature of ingestion and outcomes of children presenting to New Zealand hospitals with supratherapeutic Paracetamol ingestion. Methods: A nationwide prospective, questionnaire-based study was performed utilising the New Zealand Paediatric Surveillance Unit reporting system. Children (age 0-15 years) presenting to hospital with suspected or proven supratherapeutic Paracetamol ingestion between January 2014 and January 2016 were identified and epidemiological and clinical data were collected. Results: 128 cases were reported, including 65 intentional and 59 unintentional single overdoses. Intentional overdoses were predominantly teenage (median 14. 3 years, range 10. 9 – 15. 8), female (95%) with a mental health history (74%). This group was more likely to be admitted to hospital and 9. 2% had significant hepatotoxicity. The unintentional single overdose group was younger (median 2. 8 years, range 0. 3 – 7. 3) and had a lower rate of hepatotoxicity (1. 7%) despite ingesting the highest weight-adjusted Paracetamol dose (mean 335mg/kg). Four cases of recurrent, supratherapeutic overdoses were reported in young children who were administered excessive Paracetamol in context of a viral illness. Three of these (75%) had significant hepatoxicity. No children underwent liver transplant or died. Conclusion: This study provides unique information in regard to this important issue. The hepatotoxicity occurring in a majority of recurrent, supratherapeutic overdoses suggests that this group is at particular risk of morbidity. This study can be used to inform public health prevention measures and as a basis for future research.

Background: Paracetamol poisoning is a common cause of drug-induced liver injury, especially due to its widespread availability. This study evaluates the frequency, clinical presentation, severity, and treatment outcomes of acute Paracetamol toxicity cases at Alexandria Poison Control Center (APC) over six months. Methods: This prospective study included 75 patients admitted to the APC with acute Paracetamol overdose between July and December 2023. Data collected included demographics, exposure history, clinical examination findings, laboratory results, treatment protocols, and outcomes. Poison Severity Score (PSS) was used to assess toxicity severity. Statistical analyses examined associations between clinical and laboratory variables and patient outcomes. Results: Of the patients, 74. 7% were female, and 61. 3% were adults. Suicide attempts accounted for 76% of cases. Clinical symptoms were predominantly gastrointestinal, with 48% reporting vomiting and 37. 3% experiencing abdominal pain. The majority(72%) of cases were classified as minor toxicity based on PSS, while 8% were moderate, and only 1. 3% were severe. Most patients were presented within 24 hours, with a mean hospital stay of 1. 27 days. Liver enzyme elevation and INR correlated with prolonged hospital stay and higher PSS scores. All patients received N-acetylcysteine (NAC), with recovery observed in all cases and no fatalities. Conclusion: Prompt administration of NAC, based on estimated toxic dose, proved effective in managing Paracetamol toxicity, with all patients achieving full recovery. The study highlights the need for early intervention and underscores the role of demographic and social factors in overdose patterns. These findings support current treatment protocol and emphasize the need for preventive strategies, especially addressing intentional overdose.

Background: Drug overdose is a common health problem and recently, deliberate self-poisoning using medicinal drugs is becoming popular in both urban and rural areas of Sri Lanka. This study aimed to describe the epidemiology and clinical manifestations following drug overdose in adults. Methods: A prospective clinical study was conducted in Teaching Hospital Ratnapura, Sri Lanka over one year commencing from September 2018 including all adult patients with drug overdose. Results: There were 202 (21%) adult patients with drug overdose from which deliberate self-poisonings were 200 (99%) and accidental poisonings were 2 (1%). Females were 124 (61%) and the commonly affected age group was 15-30 years (158, 78%). The commonest overdosing agent was Paracetamol (109: 54%). Most patients (96, 47. 5%) were admitted to the hospital within 1-4 hours of the ingestion (IQR 2-4 hrs). Most of the patients (86, 42. 5%) were treated at hospital for 2 days (1QR 2-3 days). Decontamination was done for 151 (75%) of patients. Gastrointestinal symptoms including nausea and vomiting occurred prominently and they were 42% (n=89) and 53 % (n=113) respectively. Complications were detected in 15 (7. 4%) cases from which ECG changes 6 (3%), respiratory failure 5 (2. 5%), acute liver failure 4 (2%), acute kidney injury 3 (1. 5%) and hypotension 3 (1. 5%). Six (3%) were treated at the intensive care unit from which 5 (2. 5%) were intubated. There were 2 (1%) deaths and the case fatality rate of drug overdose was 1%. Conclusions: Drug overdoses are common in intentional type. Young females are mostly affected and the commonest overdosing agent is Paracetamol.

This short letter briefly reviews the significance of opioid overdose as well as the existing approaches to combat the epidemic. It also signifies the importance of naloxone, its commercially available dosage forms, and the unmet need for developing safe and effective naloxone dosage forms that can easily be administered in emergency settings.