What are the symptoms of paracetamol overdose?
There may be no symptoms for the first day. A feeling of sickness (nausea) and being sick (vomiting) may occur a few hours after taking the overdose. After 24 hours there may be pain under the ribs on the right side (where the liver is) and there may be yellowing of the whites of the eyes and the skin (jaundice). Other features include:
- The brain can also be affected with confusion and disorientation (called encephalopathy).
- The kidneys can also be affected with a reduction in urine, and kidney failure can occur.
- Low blood sugar (hypoglycaemia) may occur.
- There may be a build-up of acid in the blood, which can cause the patient to breathe faster.
- There may also be features of depression but not always.
Sometimes it is carers who will discover that someone has taken an overdose. They may find empty packets or a suicide note. It is important to bring the empty packets and notes with you to the hospital.
How is paracetamol poisoning assessed in hospital?
The healthcare professional will make a full assessment and will also ask about:
- The number of tablets taken.
- What time the overdose was taken.
- Whether the medicine was in tablet, caplet, liquid or soluble form.
- Whether any other tablets were taken at the same time.
- Whether any alcohol was taken at the same time.
- Any suicide risk, such as whether a note was written.
They will also undertake a full examination which early on may not find anything. Once liver damage sets in there may be jaundice, a tender liver and presence of brain involvement (called encephalopathy).
Further reading and references
Self harm and poisoning by sex, 2014-15; Health and Social Care Information Centre (Link to downloadable file)
Hawton K et al; Impact of different pack sizes of paracetamol in the United Kingdom and Ireland on intentional overdoses: a comparative study. Biomed central (2011)
Paracetamol overdose - revised single line treatment nomogram; Medicines and Healthcare products Regulatory Agency, Sept 2012
Ferner RE, Dear JW, Bateman DN; Management of paracetamol poisoning. BMJ. 2011 Apr 19342:d2218. doi: 10.1136/bmj.d2218.
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