New research published in the latest issue of Critical Care shows that patients who are admitted to hospital because of accidental poisoning with acetaminophen (paracetamol) are at greater risk of liver failure and death than those whose take an overdose intentionally. This is because people who poison themselves accidentally often attend hospital much later and are more likely to be alcohol abusers, two factors that greatly increase the chances of death.

Acetaminophen is an effective and safe painkiller. However, if taken in excess it can be fatal. Taking an acetaminophen overdose overwhelms the liver's ability to process the drug. The excess acetaminophen is then processed into toxic chemicals, which can kill liver cells. If enough cells are killed the patient can die from liver failure. Fortunately, a drug called N-acetylcysteine (NAC) can be given as an effective antidote for acetaminophen poisoning if the patient is treated within 12 hours of the overdose.

Doctors from the US analysed the medical records of 93 patients who were hospitalised as a result of an acetaminophen overdose, 80 were classed as suicidal with the remainder having accidentally overdosed in attempt to relieve their pain. They found that those patients who had accidentally overdosed fared less well than those who attempted suicide.

This was surprising given that the levels of acetaminophen were much lower in the patients who had taken the overdose by accident compared with those who had deliberately overdosed. Analysis of the patient's case histories revealed that those patients who overdosed by accident waited longer before going to hospital. The effectiveness of NAC, as an antidote to acetaminophen is reduced if it cannot be given at least 12 hours after an overdose is taken.

It was also shown that the patients who overdosed by accident and were more likely to heavy drinkers. Acetaminophen toxicity is made worse by alcohol consumption because the liver is attempting to eliminate two drugs from the body at the same time using a similar biochemical pathway. Thus the toxicity of acetaminophen is increased, leading to a higher risk of liver damage and death.

Acetaminophen poisoning is one of the most common types of poisoning and is placing an enormous financial burden on hospitals particularly as these patients are traditionally managed in intensive care units. The authors of this study believe at least $500, 000 could be saved in their hospital alone if patients, who have overdosed deliberately, with no history of alcohol abuse, were managed on medical floors. However they maintain that cases of accidental poisoning and in situations if the case history was in doubt should be managed in intensive care units.

This research article is freely available in Critical Care, a journal published by BioMed Central, simply visit: http://ccforum.com/content/6/2/155.

For further information contact the author, Dr Chirag R Parikh.

The accompanying commentary by can be found in the same issue of Critical Care, for access to this article visit: http://ccforum.com/info/media/cc-6-2-108.pdf.

Any articles published using the material featured in these articles should reference Critical Care, a journal published by BioMed Central. To read further press releases from Critical Care visit: http://ccforum.com/info/media/press.asp.

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