The most popular antipyretic drug among the population is paracetamol and drugs based on it: Fervex, Panadol, TeraFlu, etc. The over-the-counter medicine is considered relatively safe. Few people know that an overdose of paracetamol is dangerous to health and, first of all, to the condition of the liver and kidneys.
When should you not take paracetamol?It should be taken into account that there are a number of contraindications for taking paracetamol:
- liver diseases;
- chronic diseases kidney;
- individual sensitivity to the drug;
- alcohol abuse.
Pregnant women and nursing mothers should also take the medicine with caution. Paracetamol should not be used in combination with medicines- inducers of liver enzymes, for example, phenobarbital. If the patient is not included in the risk group, maintains the dose, and observes the time interval between doses, then there cannot be an overdose. In cases of improper use or neglect of the recommendations given in the instructions, side effects may occur.
Symptoms of paracetamol overdose
The main signs of paracetamol overdose are as follows:
- allergic reaction in the form skin rashes, itching, tissue swelling;
- abdominal pain;
- nausea and vomiting;
- excessive excitability or drowsiness;
- renal colic.
At the physiological level, hemoglobin levels drop sharply. Anticipating the question of how many paracetamol tablets can lead to an overdose, we hasten to reassure: experts have found that a single dose of 20 tablets of 0.5 g (10 g of the drug) can have a serious toxic effect. The most inquisitive ones will most likely be interested: if a person nevertheless took a critical dose, what will happen from an overdose of paracetamol?
Consequences of an overdose of paracetamol
Due to absorption, the drug spreads through the bloodstream and enters the liver. When there is an excess of the substance, a metabolic process occurs here with the release of products that destroy liver cells. Important organ stops functioning, pain sets in, and in this case the patient can only be saved by a liver transplant.
Unfortunately, in medical practice There are cases where people who took large doses of paracetamol, took several medications containing this substance, or had chronic liver diseases (hepatitis, etc.) died due to their carelessness.
Paracetamol is one of the most common painkillers and antipyretics. It is prescribed in pediatrics and approved for use in pregnant and lactating women. However, cases of drug overdose are not uncommon in doctor’s practice. Can you get poisoned with paracetamol?
Paracetamol is available in tablets of 300 and 500 mg. In addition, it comes in the form rectal suppositories and syrup for children. In this case the content active substance even less.
The lowest toxic dose of paracetamol for adults is 7.5 g, which corresponds to 15 tablets of 500 mg or 25 tablets of 300 mg.
For children, the calculation is made depending on body weight. Taking the drug at a dose of 150 mg/kg body weight and above leads to acute poisoning.
Acute overdose of paracetamol in adults can occur during a suicide attempt, but the drug is rarely used for this purpose. In children, this most often occurs due to parental neglect.
Chronic overdose of this medicine is also identified. It happens with constant pain syndrome– for example, with osteoarthritis, osteochondrosis with radiculopathy.
In the United States, up to 100,000 calls for possible paracetamol poisoning are recorded annually, many cases requiring hospitalization. In the Russian Federation and neighboring countries, this figure is somewhat lower, which is due to the low frequency of patients visiting doctors. However, given the over-the-counter sale of paracetamol, the likelihood of an overdose of this medicine is quite high. What happens if you are poisoned by this analgesic?
Mechanism of poisoning
Paracetamol is neutralized in the liver. The main role in this process is played by a special protein – glutathione. If the accumulation of paracetamol metabolites occurs very quickly, glutathione does not have time to interact with them, and the products begin to bind to liver cells - hepatocytes. The consequence of this process is their death.
If you take a lot of paracetamol tablets, it will most of is absorbed very quickly - within 2 hours, and the peak concentration of the drug in the blood will be observed after 4 hours.
In addition to the liver, other organs may be affected. In every case toxic effect due to the local influence of metabolites of this drug.
Quite often, an overdose affects the kidneys, but paracetamol can also negatively affect the central nervous system, pancreas and heart.
This drug also affects the acid-base balance of the blood, causing metabolic acidosis in the early stages.
Clinical picture
An overdose of paracetamol leads to damage gastrointestinal tract. This is manifested by the following symptoms:
- Lack of appetite.
- Stomach pain.
- Nausea and vomiting.
- Heaviness and pain in the right hypochondrium.
In addition, certain changes are observed in biochemical analysis blood. Thus, when studying liver tests, one can detect an increase in enzymes - alanine aminotransferase (ALAT) and aspartate aminotransferase (AST), bilirubin and a special indicator - INR.
Paracetamol poisoning goes through four stages of development.
First stage
The first stage of paracetamol poisoning can be diagnosed only by medical history. In this case, there is no liver damage, the levels of its enzymes are normal.
Clinical manifestations at this stage are rare; patients may present nonspecific complaints - nausea and vomiting, appetite disturbances, and poor health.
If you take 8–10 tablets (up to one pack) of paracetamol per day, the overdose may be limited to only the first stage of the pathological process.
However, the insidiousness of poisoning with this drug is that it is impossible to predict the development of toxic damage to the body. It depends not only on the dosage of the medicine, but also on the condition of the liver, as well as concomitant diseases and taking other medications.
Second stage
The second stage of poisoning is hepatotoxicity (liver damage). Often this organ begins to suffer within a day. But in any case, 36 hours after an acute overdose will be detected characteristic changes liver. It is the severity of her defeat that determines clinical picture paracetamol poisoning.
To diagnose pathological process in the liver, measure the level of aspartate aminotransferase. If its content is above 1000 mU/l, this indicates that an overdose of paracetamol has led to hepatotoxicity.
Third stage
The third stage is called acute liver necrosis. It occurs when people are poisoned by large amounts of paracetamol, as well as when they do not seek treatment promptly. medical care.
In such a situation, the peak of hepatotoxicity of the drug is observed. Clinically, this is manifested by the development of the following conditions:
- Heavy bleeding.
- Encephalopathy.
- Coma.
They are symptoms of liver failure - a terrible complication that often results in the death of the patient.
Death is possible 3–5 days from the moment of acute overdose. The number of paracetamol tablets taken should be significant.
The cause of death can be various pathological conditions. Most often this is:
- Brain swelling.
- Sepsis.
- Bleeding.
- Acute respiratory failure– adult respiratory distress syndrome (ARDS).
- Multiple organ failure is a dysfunction of vital organs.
In a biochemical blood test at the third stage of poisoning, high numbers of AST and ALT can be detected. Changes in the following laboratory parameters are also determined:
- bilirubin;
- lactate;
- phosphates;
- Blood pH.
These data make it possible to assess the degree of liver failure and calculate the prognosis.
Fourth stage
The fourth stage is the restoration of the body after poisoning. If the outcome is favorable, the analgesic overdose is completed full restoration liver parenchyma and its functions. The organ begins to work at full capacity again. The same is observed from other systems.
The fourth stage can last a long time. The recovery period takes from two weeks to several months, depending on the extent of the damage.
Diagnostics
Considering high risk development of liver failure due to poisoning with this medicine, it is necessary to establish the correct diagnosis as soon as possible.
Clinically, at the first stage, it is almost impossible to determine an overdose due to nonspecific complaints. That is why anamnesis data comes to the fore. Mention of pills taken paracetamol should make the doctor think about possible poisoning.
Sometimes patients arrive in an unconscious state after a suicide attempt. In this situation, it is also necessary to remember about the possibility of a deliberate overdose of this analgesic and conduct an appropriate examination.
In order not to prescribe unnecessary treatment, the doctor must correctly assess the risk of complications and do this as quickly as possible. Postponement specific therapy increases the likelihood of liver damage.
Risk assessment
If there is evidence of simultaneous use of a large dose of paracetamol, it is necessary to assess the risks of complications. This should also be done if a potentially toxic dose was taken within 4 hours.
However, information about overdose must be true. If it cannot be confirmed, or there is reason to suspect fiction, one can only rely on the levels of analgesic in the blood serum.
The risk of developing liver failure is calculated using a special Ramack-Matthew nomogram. This method is not without drawbacks due to the low specificity of the nomogram, although its sensitivity is quite high.
For correct assessment risk, it is important to know exactly the time of poisoning, the indicators of AST and ALT, and serum paracetamol.
The last indicator is determined no earlier than 4 hours after taking the tablets, and this analysis cannot be delayed.
Specific treatment is considered effective if it begins no later than 8 hours after the overdose. This interval allows the specialist to conduct all the necessary studies and prescribe therapy in accordance with the results.
Chronic overdose
If there is evidence of chronic abuse of paracetamol, the doctor will also need to carry out a risk assessment.
There are no clear criteria for such a clinical situation, but it is necessary to at least roughly assess the likelihood of liver damage.
It has not yet been proven that alcohol abuse in combination with an analgesic overdose more often causes liver failure. It is also rarely observed if an adult consumes no more than 4 g medicine in a day. However, it is unknown how it will turn out long-term use this amount of paracetamol.
If there is a serious suspicion of poisoning with this drug and the dose is systematically exceeded, it is necessary to determine the level of the active substance in the blood serum and liver enzymes. If the risk of hepatotoxicity is high, specific therapy begins.
If the patient shows signs of liver damage during examination, then treatment begins regardless of the risk factors and their assessment.
Treatment
In case of poisoning with this analgesic, there is usually no need for gastric lavage, since the medicine is absorbed very quickly. Early administration of highly effective sorbents can reduce the number of patients with critical serum paracetamol concentrations. However, most effective treatment is the use of a specific antidote - acetylcysteine.
It limits the formation of toxic drug metabolites and protects hepatocytes. If acetylcysteine is prescribed in the first 8 hours, the likelihood of developing liver failure is significantly reduced.
The medicine can be administered orally and intravenously. But parenteral route is fraught with more high frequency development allergic reactions. In most cases, their course is mild, but the likelihood of death anaphylactic shock cannot be excluded.
There are several schemes for administering acetylcysteine, all of them are effective. In case of severe damage to hepatocytes, the course of treatment is extended. In cases of severe organ necrosis, liver transplantation may be necessary.
Although paracetamol is considered safe medicine, an overdose can lead to severe complications and even to death.
Paracetamol is a medicine that is available in almost every home. It is used as an antipyretic and analgesic, without thinking about the danger this seemingly harmless medicine poses. After all, it can be given even to children. This raises the question: is it possible to get poisoned by paracetamol?
This medicinal substance began to be actively used in the mid-20th century. It is part of large quantity drugs. And cases of paracetamol overdose, sometimes fatal, are increasingly appearing. Every person should know how to avoid tragic consequences, what are the signs of poisoning and what to do in case of emergency situation. We will discuss these questions below.
Why is paracetamol dangerous?
When paracetamol enters the body, most of the drug enters the blood within the first two hours. Maximum concentration achieved after four hours. Paracetamol is eliminated bypassing the liver. Dangerous metabolites are formed under the action of a special (microsomal) enzyme system of the liver - cytochrome P-450. Neutralization is carried out by a tripeptide - glutathione.
If a small amount of paracetamol enters the body, then the toxic products of its metabolism are bound in the liver by glutathione and eliminated without causing harm. In case of excess intake medicinal substance glutathione reserves may not be enough, and the metabolites begin to bind to the proteins of the liver cells, which leads to their death and the appearance of symptoms of paracetamol overdose.
Metabolic products have toxic effects on the kidneys, pancreas, heart and central nervous system. Promote the development of acidosis (pH shift to the acidic side) and depression of consciousness.
Maximum daily dose paracetamol for an adult is 4 grams, if there are liver diseases, then even less. A single dose of 7.5–10 grams leads to symptoms of intoxication. The lethal dose is 25 grams.
Causes of paracetamol poisoning:
- suicide attempt;
- accidental ingestion of a large dose resulting from the concomitant use of paracetamol and combined agents in which it is present: Citramon, Pentalgin, Caffetin, Ibuklin, Theraflu, Fervex, Rinzasip;
- combination with alcohol;
- simultaneous use of drugs that stimulate the activity of cytochrome P-450: Phenobarbital, antihistamines, hormones, Ethacrynic acid;
- chronic liver diseases;
- long-term use of large doses of the drug.
Symptoms of paracetamol overdose
There are four stages acute poisoning.
In the first stage they appear nonspecific symptoms paracetamol poisoning. Appears general malaise, nausea and vomiting. Laboratory indicators within normal limits.
The second stage begins a day or a little more after taking paracetamol. During this period, signs of liver damage appear. The severity of the condition depends on the extent of the lesion. There is an increase in the blood liver enzymes: ASAT and AlAT. Indicators exceed 1000 U/l.
The third stage begins after 72–96 hours. Acute necrosis (death) of the liver develops. Bleeding appears, hepatic encephalopathy develops, which can progress to coma. The activity of liver enzymes is very high and can exceed 10,000 U/l. Bilirubin levels increase and glucose levels decrease. The concentration of lactic acid in the blood increases, the pH of the blood decreases - acidosis develops.
Symptoms of acute liver failure:
Death as a result of an overdose of paracetamol can occur within 3–5 days. Causes of death: failure of all organs and systems, bleeding, cerebral edema or sepsis.
The fourth stage is recovery. Due to the fact that the liver has the ability to regenerate, its rapid recovery occurs. This period can take up to several weeks.
Diagnosis of poisoning
If an overdose is suspected, it is necessary to examine the level of paracetamol in the blood. To determine the need to use an antidote, the Rumak-Matthew nomogram is used, which allows one to predict the severity of liver tissue damage.
The study is done 4 hours after the medicine enters the body. To do this you need to know exact time poisoning If not clinical manifestations and the concentration is less than 150 mcg/ml, then there is no danger. With more high content toxic substance, the risk of liver damage is very high and immediate administration of an antidote is required.
First aid and treatment
As in any emergency situation, you need to clearly know what to do in case of an overdose of paracetamol. If you suspect that you have taken a large dose of a drug, you must do the following.
- Rinse the stomach with plenty of water.
- Accept Activated carbon, the dose of which depends on body weight, approximately 1 tablet per 10 kilograms of weight. This will prevent further absorption of the toxic substance.
- Call an ambulance.
The main antidote is Acetylcysteine, which is a precursor to glutathione. As a result of its administration, the toxic metabolic products of paracetamol are neutralized and removed from the body. Optimal time taking the drug - the first 8 hours.
The antidote is taken orally or as an intravenous infusion. Initial dose at orally(oral) is 140 mg/kg body weight. After this, every 4 hours take a dose 2 times less. To improve the taste, the medicine can be diluted in a 1:4 ratio with juice or carbonated drink.
For infusion therapy(injections) Acetylcysteine is diluted in 200 ml of 5% glucose or saline solution. The initial dose is 150 mg/kg body weight, after which treatment is continued in smaller doses for 16 hours.
In mild cases, you can use Methionine, which is also a source of glutathione. Taken orally at intervals of 4 hours, 2.5 grams.
With the development of severe liver failure, symptomatic treatment is carried out:
- detoxification therapy: plasmapheresis, hemosorption, hemodialysis;
- to improve microcirculation, metabolism, restore electrolyte balance and eliminate acidosis, solutions of glucose, albumin, rheopolyglucin, hemodez are administered intravenously;
- to avoid cerebral edema during infusion therapy, Mannitol is administered;
- vitamin therapy: B vitamins, Ascorbic acid;
- at hemorrhagic syndrome It is advisable to introduce: Vikasol, Aminocaproic acid, Etamsylate;
- during development pronounced violations plasma is infused to improve the blood coagulation function;
- if such a need arises, antibiotics are prescribed;
- Oxygen inhalation is used to combat hypoxia.
The consequences of an overdose of paracetamol may be such that a liver transplant may be required to save a person's life. In mild cases the outcome is favorable. The prognosis depends on the dose of the drug taken, timely treatment started and adequate therapy.
Features of paracetamol poisoning in children
Oddly enough, paracetamol poisoning is much easier in children than in adults, especially in those under 6 years of age. This is due to the characteristics of metabolism. For child's body A dose of 150 mg/kg body weight is dangerous. Signs of liver failure are extremely rare.
The principles of care for paracetamol overdose in children are similar. Only the doses of the antidote and the amount of fluid administered differ when intravenous infusions. In mild cases, treatment at home is possible.
How to avoid paracetamol poisoning
Prevention in this case is very important if there is no desire to experience for yourself what will happen from an overdose of paracetamol.
- take the medicine as prescribed by the doctor in an acceptable dose, with an interval of at least 4 hours;
- in case of existing liver diseases, the dose of the drug should be reduced;
- Do not combine paracetamol with other medications containing this substance; before use, you must study the composition of the combined products;
- the duration of treatment with paracetamol should not exceed five days;
- avoid taking alcohol and medications that increase the metabolism of paracetamol;
- medications should be kept out of reach of children.
To summarize, we can conclude that everything is good in moderation. Even the usual medicine can cause irreparable harm to health. You cannot prescribe treatment for yourself; always seek advice from a doctor!
Paracetamol is recognized as a very controversial drug that has pain-relieving properties. It is important to note that many pharmacists have proposed banning Paracetamol more than once. Nevertheless, it is actively used in the therapy of children and adults, as it is a very effective antipyretic and analgesic.
The active ingredient of the drug is acetaminophen, which occupies the lion's share in the composition of many antiviral and cold medicines, powders and mixtures. Due to active use, about twenty thousand poisonings with such combination drugs are recorded annually.
The main blow in an overdose of Paracetamol goes to the liver. Poisoning is possible only when there is a strong excess of the dosage or prolonged use. In such a situation, it is important to consult a doctor in a timely manner to avoid many undesirable consequences and complications.
An overdose of Paracetamol in children and adults may result from a single dose of a large number of drugs containing this substance, or an excessively long course of treatment with such drugs. An overdose has a rather detrimental effect on an adult, but even more so on a child. Therefore, if you discover suspicious symptoms, you must definitely call the emergency team.
It should be remembered that any drug poisoning can cause serious negative health consequences and can also cause death. Every day many people die from such poisonings, therefore, if possible, it is necessary to urgently take the victim to the hospital, but not to self-medicate.
Entering the human body, Paracetamol penetrates the blood within two hours. Its maximum concentration is created in the blood after four hours. Therefore, after taking one tablet, you should not immediately take another if the first one did not help. You need to wait a little, otherwise the consequences may be very sad.
When a small portion enters the body medication, binding of toxic metabolic products in the liver is observed, which occurs due to the effects of glutathione. As for elimination, it occurs without any harm to health. Signs of an overdose may appear when an excessive amount of medication enters the body. IN in this case Glutathione deficiency develops, so liver protein binds to metabolites, and this provokes the death of liver cells. Against the background of such a process, symptoms of intoxication develop. To the question of whether it is possible to die from an overdose, the answer will be positive, since everything depends on the individual characteristics of the body, the dose of the drug and the time of exposure.
Such metabolic products have a strong toxic effect on the heart, kidneys, central nervous system and pancreas. It is important to note that such a picture contributes to the depression of consciousness and provokes the development of acidosis. As for the daily dose of Paracetamol, for an adult it is four grams, but if there are liver pathologies, then much less. A single dose of 7.5-10 grams can cause acute poisoning. As for the lethal dosage, it is about twenty-five grams for an adult.
Causes of intoxication:
- accident;
- suicide;
- combining medications with alcoholic beverages;
- intentionally exceeding the dose in order to enhance the therapeutic effect;
- simultaneous use of Paracetamol with certain drugs: corticosteroids, antihistamines and hypnotics;
- the presence of chronic liver pathologies;
- prolonged use of large doses of medication.
To avoid overdose and poisoning, it is important to follow the instructions and not self-medicate, because this can be very dangerous and even fatal.
Clinical picture of Paracetamol poisoning
In case of intoxication, even death cannot be ruled out; it depends on the age and weight of the patient, as well as the presence of concomitant diseases. To prevent serious complications and death, it is important to promptly detect pathogenic symptoms, which indicate that there is an overdose. In this case, emergency medical attention may be needed.
Symptoms of poisoning look like this:
- The first stage is characterized by the absence of any external manifestations, even appropriate laboratory tests cannot identify the problem.
- Literally after twenty-four hours, and in children after twelve, liver damage begins to develop. Considering the level and volume of drug overdose, symptoms can vary significantly. Abdominal pain, vomiting with nausea, heartburn, flatulence, and diarrhea occur. Other systems of the body also suffer, which is characterized by rapid heartbeat, shortness of breath, headache, lethargy, even coma.
- In the third stage, in the absence of proper medical care, acute liver necrosis develops. In this situation, death may occur on the third to fifth day due to the development of hepatic encephalopathy.
- As for the fourth stage, this is the rehabilitation stage, if the drug is completely evacuated from the human body. In this case, the liver recovers completely in just a few weeks, but this will require a course of intensive therapy.
Video
First aid for poisoning
As with any drug poisoning, it is important to act very quickly and wisely so as not to make common mistakes.
Algorithm for providing first aid to a patient:
- perform a gastric lavage procedure with plenty of water;
- give him activated charcoal;
- call the ambulance team.
The main antidote of Paracetamol is acetylcysteine, it is a precursor for glutathione. Thanks to its use, it is possible to neutralize the breakdown products of the drug, as well as evacuate them from the victim’s body. The ideal period for taking the antidote is the first eight hours after poisoning. The antidote must be taken orally or administered intravenously. Primary dose – 140 mg/kg human weight; then for every two hours you need to take a half-reduced dose.
Thus, in case of Paracetamol poisoning, it is necessary to urgently seek medical help, as complications can cause serious liver damage and death. Take care of yourself!
Drug poisoning among children and adults is a very pressing problem. Therefore, it is very important to carefully study the instructions before taking the drug, and also store medications out of the reach of children.
Paracetamol overdose in adults
Exceeding the permissible dose of a drug in an adult has serious consequences. The daily dose of the drug for adults is 3-4 g , and you should not take more than 1.5 g of Paracetamol at a time. Death or toxic damage liver damage can occur with a single dose of 140 mg per 1 kg of weight. Paracetamol tablets may contain 0.2, 0.325 and 0.5 g of the active substance. Therefore, if you take 5 Paracetamol tablets containing 0.2 g of the active substance at a time, this amount will not exceed the maximum permissible single dose and is safe.
Also, the maximum permissible daily dose of the drug should not be exceeded. If you take 20 Paracetamol tablets of 0.2 g each during the day, you will not exceed the daily dose (3-4 g) and the risk negative consequences minimum. However, if you take 20 tablets of 0.5 g each, symptoms of overdose and intoxication will appear:
- drowsiness;
- dizziness;
- nausea, vomiting;
- pallor of the skin and mucous membranes.
Overdose in children
When calculating the dose of the drug for a child, it is necessary to take into account his weight. If you do not calculate the dose accurately, there is a high risk of overdose. For children under 3 months, the frequency of administration and dosage of the drug is selected exclusively by the doctor. For older children single dose is 10-15 mg per 1 kg of weight. The maximum daily dose is 60 mg per 1 kg of weight; if it is exceeded, symptoms of intoxication and side effects from the drug.
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