Paracetamol overdose in adults

Given the lack of symptoms, or the non-specific symptoms associated with initial paracetamol toxicity, potential unsuspected paracetamol toxicity is a concern in acute overdose or repeated supratherapeutic ingestions. However, the overall risk of unsuspected paracetamol toxicity in suicidal ingestions is small, and some studies have questioned the routine check of serum paracetamol concentration in all patients presenting with a history of intentional self-harm, while others recommend that the risk of this treatable life-threatening overdose warrants universal paracetamol screening in all suicidal ingestions.[49]Lucanie R, Chiang WK, Reilly R. Utility of acetaminophen screening in unsuspected suicidal ingestions. Vet Hum Toxicol. 2002 Jun;44(3):171-3. http://www.ncbi.nlm.nih.gov/pubmed/12046974?tool=bestpractice.com [50]Sporer KA, Khayam-Bashi H. Acetaminophen and salicylate serum levels in patients with suicidal ingestion or altered mental status. Am J Emerg Med. 1996 Sep;14(5):443-6. http://www.ncbi.nlm.nih.gov/pubmed/8765104?tool=bestpractice.com

All patients who present in coma or with decreased levels of consciousness and are thought to have taken an overdose or self-harmed in any other way should have a serum paracetamol concentration level checked. A serum aspartate aminotransferase or alanine aminotransferase level should be obtained in patients with a history of frequent or repeated use of medications for pain relief.