Posted on: Tue 30-04-2024

Specialists in the treatment of disorders and diseases affecting the liver and other digestive systems have warned that taking four or more doses of paracetamol instead of the prescribed two raises the risk of developing acute liver failure, organ damage, and death.

The physicians said despite how simple paracetamol may appear, abuse or overdose of it can cost a life.

They insisted that paracetamol should be taken according to the doctor’s prescription.

According to the University Hospitals Sussex NHS Foundation Trust, paracetamol is a common painkiller and is present in many cold and flu preparations, and often combined with other painkillers.

It warns that paracetamol can cause harm when taken in amounts above the recommended daily dose, insisting that when too much of it is taken, it overwhelms the body’s defence against one of the breakdown products of paracetamol, which results in liver and kidney damage.

“The damage can be severe enough to need a liver transplantation and if you are unable to get a transplant in time you could die of liver disease. Liver disease can lead to bruising easily, bleeding, and swelling of your tummy,” it added.

The specialist, who spoke exclusively with PUNCH Healthwise in different interviews, said paracetamol overdose remains one of the most common causes of poisoning worldwide.

A Professor of Public Health at the University of Ilorin Teaching Hospital, Kwara State, Tanimola Akande, said an overdose of drugs is dangerous to health.

According to him, appropriate drug dosage is related to the weight of the patient and the severity of the illness as determined by doctors.

He said, “Overdosing on paracetamol also known as acetaminophen can be extremely dangerous and may lead to severe health complications, including liver damage and failure.”

“The acetaminophen, depending on dosage and duration of use, can harm the liver, which is the organ that metabolises the drug. The liver primarily metabolises paracetamol. So, when there is an overdose, the capacity of the liver to process it is overwhelmed.

“This leads to the accumulation of toxic by-products that can damage liver cells. The kidney can also be damaged with an overdose of Paracetamol, though not as common as damage to the liver.

“However, the extent to which paracetamol can cause organ damage and death is dependent on the level of overdose and the condition of the patient, particularly if the liver is already compromised.”

Warning against self-medication, Akande urged the masses to desist from any form of paracetamol overdose.

“Self-medication is dangerous and should be avoided. Patients should endeavour to see their doctors for treatment and use drugs as prescribed,” he advised.

Corroborating his position, a Consultant Gastroenterologist and Paediatrician at the Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Dr Adefunke Babatola said though the dose of paracetamol is wide, using paracetamol for a long time above the normal dose can cause damage to the liver.

According to him, a certain quantity of it can cause acute liver failure, while prolonged use of paracetamol in children will lead to hepatic (liver) failure.

Babatola, who revealed that had handled three cases of paracetamol overdose, said the cases ended in mortality and warned mothers who overload their children with paracetamol to discontinue such acts.

She said, “Paracetamol overdose is a serious condition that has always ended in fatality, especially if such a case is presented after 15 minutes of injection of the paracetamol. This drug shouldn’t be taken against a doctor’s prescription.”

Speaking on the treatment, Babatola said, “The treatment of paracetamol overdose is often cost-intensive and requires machines like dialysis and chemoperfusion, but the prognosis is often bad because the ultimate treatment most times is a liver transplant.

“But if the poisoning is known on time and the individual is brought to the hospital on time within 10 and 15 minutes of paracetamol injection, we can do a gastric lavage procedure to take some of the tablets away from the stomach.

“We pass a feeding tube into the patient’s system, using normal saline to take away the paracetamol that has not been absorbed in the stomach. This procedure will reduce the amount of paracetamol that will get into systemic circulation, which would cause liver failure.

“But once it is established, the prognosis is often very poor, particularly in a developing country like Nigeria, where there is no provision for liver transplantation. There are only a few centres that do liver transplantation in the country.”

Speaking on the survival rate, Babatola added, “If the individual is brought in within 10 minutes of overdose and there has not been a liver failure, the prognosis is good but once we start seeing signs of liver failure, such as prolonged bleeding, the prognosis is not good at all.

“I have had a cause to manage three cases and they all resulted in mortality. They died of chronic use of paracetamol. Also, there was a baby that was prevented within four months of life and the baby died of liver failure too.”

Shedding more light on this, a study published in the National Library of Medicine by Dina Abushanab et al, titled, ‘Patterns and outcomes of paracetamol poisoning management in Hamad Medical Corporation, Qatar: A retrospective cohort study,’ affirms that paracetamol overdose can cause liver damage, acute liver failure, and even death.

According to the study, paracetamol overdose also accounts for a high number of emergency admissions and calls to poison centres in the United States, increases direct costs, and consequently places a burden on healthcare expenditure.

The study noted that paracetamol toxicity remains one of the most common causes of poisoning worldwide, accounting for approximately 17 per cent of the cases in Qatar.

“Moreover, compared with other poisoning cases, paracetamol toxicity is the leading cause of mortality. It is widely used as a counter painkiller in Qatar,” the study stated.

It noted that Intravenous N-acetylcysteine is the mainstay treatment for paracetamol overdose, stating that the standard local administration of NAC in adults is the 3-bags (21 hours) protocol.

“Based on clinical investigations, NAC should be discontinued once patients recover from toxicity. To date, only a limited number of studies have evaluated paracetamol overdose or toxicity, and most have been conducted in Western countries,” the study added.

---

---