Paracetamol poisoning in the North East of England: presentation,early management and outcome

1 Paracetamol is increasingly involved in self-poisoning in the United Kingdom and remains a common cause of fatal poisoning.

2 To document the epidemiology and early management of paracetamol poisoning data were collected on consecutive patients with suspected paracetamol poisoning presenting to 6 hospitals in the North East of England over 12 weeks in 1994.

3 There were 400 presentations (attendance rate 1.14/10³ population/yr) involving 343 persons (45% male). Paracetamol concentrations at 4 h correlated weakly with reported paracetamol dose (R=0.49, P < 0.0001) and were similar comparing those treated and not treated by gastric decontamination.

4 In 38 (9%) cases paracetamol concentrations were above the appropriate nomogram treatment line, including 3% and 20% of patients who reported ingesting less than and more than 12 g respectively. In 21 patients acetylcysteine treatment was deferred until admission to the ward, the mean delay involved was 2.8 h.

5 One patient died, from arrhythmias caused by co- ingested dothiepin.

6 Paracetamol poisoning is common. Most cases do not have potentially toxic plasma paracetamol concentra tions, but those who do often present late and antidotal treatment may be delayed inappropriately.