Paracetamol is one of the most popular drugs that is in almost any first aid kit. From fever and pain, and almost from a bad mood, people are used to taking paracetamol, and just as easily and without thinking about the possible consequences, they give it to children. Since this substance has been proven to be effective for decades and is an active ingredient in more than 100 drugs, at first glance, there is nothing wrong with this. It is not for nothing that paracetamol is one of the most important medicines recommended by the WHO. However, the specificity of paracetamol is such that it requires precise adherence to the dosage and regimen, and also does not allow self-medication.

Paracetamol: benefits and harms to the body

Paracetamol-based preparations perfectly relieve even severe pain, as they inhibit pain centers, they prevent inflammatory processes and regulate the work of the thermoregulation center of the brain, and they act quickly and retain their effect for up to 6 hours. If paracetamol is used in the doses recommended by the instructions, it is characterized by low toxicity and, at the same time, high efficiency, so the worldwide popularity of drugs based on it is completely understandable and deserved. That is why paracetamol is among those allowed for use even by small children up to a year old: children's Panadol is based on paracetamol.

But if all this is so, is it possible to poison yourself with paracetamol?

Paracetamol forms compounds that are hazardous to health during metabolism, which normally bind in the liver and are safely excreted from the body if the dose was therapeutic. If there is an overdose, the body simply may not have enough of the binding component - glutathione, and then the decomposition products of paracetamol are bound by proteins of the liver cells, which die as a result - this is what paracetamol is dangerous for. However, the harmful effects are not limited to this: virtually all key organs are affected: the heart, kidneys, pancreas and central nervous system.

Paracetamol poisoning is possible in the case of:

• erroneously high doses (this happens with old people who take drugs uncontrollably, and with babies who suddenly get to the first-aid kit and are able to immediately drink a bottle of children's remedy for fever and pain, because it has such a sweet, pleasant taste!)
• taking several drugs based on paracetamol at the same time: even if the dosage of each drug was not exceeded, in total they give an overdose;
• taking several drugs that affect the liver at once: drugs with paracetamol, antihistamines, barbiturates (hypnotics and sedatives);
• taking drugs based on paracetamol along with alcohol: for the period of treatment, any alcohol is strictly prohibited, as it additionally jeopardizes the work of the liver;
• the use of medicines based on paracetamol for liver diseases (this is a contraindication for taking);
• prolonged and uncontrolled use of the drug in large doses;
• in cases of individual intolerance (allergic reaction or hypersensitivity to the drug);
• with intentional poisoning (suicide).

What are the symptoms of paracetamol overdose?

You need to know the symptoms of intoxication in order to prevent trouble in time: by orienting yourself by external signs, you can save health and even life, for example, a small child or an elderly person.

Paracetamol-based preparations act somewhat differently on adults and children. They also have different features of exposure at different stages of intoxication. If we are dealing with acute poisoning, then the picture will be as follows:

• Stage one: the first day there are signs of general intoxication: feeling unwell, pallor and sweating, headache, nausea, sometimes vomiting, refusal to eat due to lack of appetite. However, if tests are taken at this time, they will be within the normal range.
• Stage two: after 24 hours, symptoms of liver damage begin to appear: heaviness and pain under the ribs on the right, and an increased level of liver enzymes is observed in blood tests. But the previous symptoms gradually disappear, because of which it may seem that the malaise recedes.
• Stage 3: On days 3-5 without assistance, the liver gradually dies.
  • The whole body swells and multiple bleedings are observed (from the gums, stomach, nasal, etc.)
  • There are disturbances in the functioning of the brain () - alternation of excitement and drowsiness, convulsions can be observed, speech is disturbed, thinking becomes slow, delirium and hallucinations appear, consciousness is confused - up to a coma.
  • The analyzes show very high level liver enzymes and bilirubin, and the acidity of the blood increases due to the formation of lactic acid - these are symptoms of acidosis.
  • The skin and mucous membranes become yellowish, the pain in the hypochondrium on the right is very strong, there is absolutely no appetite and vomiting follows vomiting.
  • Urine becomes less and less until urination disappears altogether.
  • Cardiac activity is also disturbed, tachycardia is observed.
  • Body temperature drops.
  • There is a decrease in the size of the liver.
  • Another sign is an unpleasant "liver" smell from the mouth.
• Stage 4. After 5 days, if help did not come or the treatment was ineffective, the person dies due to the failure of all organs and systems, massive bleeding, sepsis (blood poisoning) and cerebral edema. If a person received adequate treatment or at least took an antidote on time, at this stage the body's work is restored and functions are normalized - lasting up to 14 days.

With chronic overdose of paracetamol, symptoms such as:

• loss of appetite and frequent nausea and vomiting;
• inexplicable lethargy, apathy;
• yellowish tint or pallor of the skin and mucous membranes;
• bleeding gums or from the nose, the appearance of bruises (hematomas) on the body;
• discomfort or pain on the right under the ribs.

An overdose of antipyretics in a child

If an overdose of paracetamol occurred in a baby, especially younger than 6 years old, then, surprisingly, the process is not as difficult as in adults, and the consequences are not so formidable: at least, liver damage is not so pronounced and critical. This is explained by the peculiarities of metabolic processes in children: their intensity and speed are much higher, so the body is much more likely to cope with intoxication on its own.

However, this does not mean that taking paracetamol-containing drugs for a child is safe and that it can be self-prescribed and dosing carelessly. A lighter course and consequences does not mean their absence, and in severe cases, a tragic outcome is also possible.

In addition, if we talk about newborn babies (less than 1 month old), then an overdose of paracetamol is extremely dangerous for them. It can instantly stop the liver and cause the death of the child. That is why young children are prescribed medicines for fever and pain from those that do not contain paracetamol.

Consequences of intoxication with paracetamol

Paracetamol poisoning can result in:

• acute liver and kidney failure, acute pancreatitis, as well as failure of all organs and systems of the body;
• brain damage (encephalopathy) of toxic origin;
• pulmonary edema of toxic origin;
• heart complications - myocarditis;
• coma and death.

Since the main target of paracetamol is the liver, in case of an unfavorable development of events, a liver transplant may even be required. If the treatment was started on time and carried out correctly, the prognosis of the condition is considered favorable.

Antidote for paracetamol overdose

Is it possible to avoid such severe consequences?

Of course, yes - if in the first 8 hours after poisoning you take an antidote, which is acetylcysteine ​​​​(it is he who is the active ingredient in the ACC drug, a popular cough medicine sold in any pharmacy). Its action is aimed at binding and neutralizing, and then removing from the body the toxic decay products of paracetamol. In a medical institution, the antidote, of course, is administered not only in the form of tablets, but also by intravenous injections.

First aid for paracetamol poisoning

If the situation is such that it is you who urgently needs to be treated for an overdose of paracetamol, you need to act quickly and according to the rules:

• call immediately ambulance.
• Rinse the stomach by drinking a large amount of salted water (at least a couple of glasses), and if necessary, by pressing on the root of the tongue to initiate vomiting.
• Take (polyphepan, polysorb, etc.) to bind and remove toxins. It is important to know that activated carbon blocks the action of the acetylcysteine ​​antidote, so they cannot be used at the same time: if an antidote is introduced, coal is not used as a sorbent.
• Take a laxative to cleanse the bowels.

Preventive measures

It is important to follow these simple rules. and thereby protect yourself from severe poisoning:

• Keep paracetamol (as well as the rest of the first aid kit) in a place completely out of the reach of children.
• Take drugs with paracetamol only according to the scheme indicated by the doctor or in the instructions (with the obligatory maintenance of a four-hour interval and no longer than 5 days).
• Do not self-medicate and do not take (and also do not give children) paracetamol for any reason, this can lead not only to intoxication, but also to other negative consequences: for example. to an increased risk of developing asthma.
• Do not use expired drugs: their effectiveness is reduced and there is a desire to achieve the desired result by increasing the dose, which is fraught with an overdose with all its unpleasant consequences.
• Strictly adhere to contraindications, do not take drugs with paracetamol or reduce their dose to a minimum (as the doctor decides):
  • in diseases of the liver, kidneys and gastrointestinal tract
  • with bronchial asthma
  • pregnant in the last trimester
  • people with individual intolerance
• Do not combine the use of drugs with:
  • drinking alcohol (here the prohibition is categorical, even if it is “just” beer);
  • taking medications that enhance the effect of paracetamol;
  • taking medications that also contain paracetamol.

Be careful with the use of even familiar and seemingly harmless drugs, such as paracetamol, and this will save your health.

Paracetamol is known to everyone as an antipyretic, analgesic drug. It began to be actively used for these purposes in the middle of the 20th century. It is present in more than 200 cold and flu medicines in the form of suppositories, syrups, capsules, and tablets.

Source of danger

When paracetamol enters the body, a good half of it enters the bloodstream during the first 2 hours. This drug reaches its maximum concentration after 4 hours. It is excreted from the body without passing through the liver. Getting under the influence of a special enzyme (microsomal) system of the liver, very harmful metabolites are formed from the components of this drug. Neutralization occurs with the help of a tripeptide - glutathione.

Possibility of intoxication

When the optimal amount of the drug enters the body, the toxic elements, as a result of metabolism, are bound by glutathione (a liver enzyme) and excreted without any harmful effects.

With excessive intake, when an overdose of paracetamol occurs, the reserves of this enzyme may not be enough. In such a case, the metabolites combine with the protein cells of the liver, which leads to their death.

Moreover, it entails paracetamol poisoning.

Safe Rate

The maximum daily allowance for an adult is considered to be 4 grams. Children count maximum dose it is necessary for 1 kg of weight 90 mg of the drug.

The duration of the course corresponds to 5-7 days.

For a person suffering from liver disease, this dose is even less. A single dose of 7.5-10 grams can provoke paracetamol poisoning.

The lethal dose of paracetamol for an adult is 25 grams.

According to the instructions, a one-time norm for an adult weighing up to 40 kg is recommended for a norm equal to 500 mg, and 1 g for a weight of more than 40 kg. The frequency of receptions should not exceed 4 times.

Causes of intoxication

When asked if paracetamol can be poisoned without violating the dosage, the answer is yes. A similar situation is possible with alcoholism, the presence hereditary diseases liver, the practice of fasting, the joint use of medications (rifampicin, isoniazid, etc.).

Situations that provoke paracetamol poisoning are:

Signs of intoxication

When paracetamol poisoning occurs, symptoms appear after 10 hours or a day:

• nausea, gag reflexes;
• sharp pain in the right hypochondrium;
• lack of appetite;
• lethargy and malaise.

After 36 hours, the main signs are supplemented by the following:

• drop in body temperature and pressure;
• severe pain in the abdomen;
• severe renal failure;
• a drop in the content of glucose and platelets in the bloodstream;
• excessive sweating;
• delirium, convulsions, development of a coma;
• development of liver failure and jaundice.

In this case, emergency medical attention is needed.

The course of the disease

Paracetamol poisoning has 4 stages. Each is characterized by certain signs and the degree of harm caused.

I stage

Symptoms of this stage appear after an hour or a day after taking the drug. At mild degree there are practically no signs.

The average is characterized by nausea, vomiting, excessive sweating, anorexia, blanching of the skin. results laboratory research while remaining within acceptable limits.

In a severe course of the disease, the liver, cardiovascular system, and pancreas suffer significantly. Violation of consciousness does not occur, but unexpressed lethargy is observed.

II stage

Symptoms of this stage may appear after 24 hours or 3-4 days. In such a case, pain is felt in the region of the right hypochondrium, an increase in the liver is observed.

In the case where the intoxication is caused by a moderate dose of the drug, the symptoms do not increase and the patient is cured.

When toxemia is caused by an overdose, the symptoms progress, the liver suffers, the level of bilirubin and marker enzymes for the myocardium increases to 1000 IU / l.

III stage

Symptoms appear after 3-5 days.

A moderate level of severity is characterized by reverse dynamics of symptoms and a speedy recovery.

The severe stage is characterized by a toxic form of liver damage. The indicators of marker enzymes for the myocardium more than 10,000 IU / l and bilirubin are growing. There is a violation of consciousness, a decrease in sugar levels. Jaundice and kidney failure develop. In addition to everything, blood pressure decreases, as well as body temperature.

IV stage

It makes itself felt after 5 days after taking an increased dose of the drug. Often such situations occur during attempts to commit suicide.

Irreversible liver failure develops, leading to death.

Urgent care

Methionine is an antidote for mild poisoning.

Often people are poisoned both intentionally and negligently. If poisoning is suspected, a number of measures must be taken:

• call an ambulance;
• perform gastric lavage;
• take sorbents.

During the arrival of the medical team, the specialist will decide on hospitalization. In a hospital, the victim will be given the antidote Acetylcysteine. The period of taking this medication is the first eight hours. It can be taken orally or administered intravenously.

The initial dose corresponds to 140 mg/kg of the patient's weight. Then, every 4 hours, the dosage is halved.

With a mild degree, methionine can be used. It should be taken in 2.5 grams. with an interval of 4 hours.

• detoxification;
• restoration of electrolyte balance;
• the introduction of mannitol to avoid cerebral edema;
• vitamin therapy;
• elimination hemorrhagic syndrome(administer vikasol, etamzilat);
• plasma infusion;
• the use of antibiotics;
• oxygen inhalations to avoid hypoxia.

The consequences of toxemia with paracetamol are fraught with liver transplantation.

Paracetamol poisoning can cause gastroenteritis within a few hours and liver damage within 1-3 days after ingestion. The severity of liver damage after a single acute overdose can be predicted by the concentration of paracetamol in the blood plasma.

Treatment with acetylcysteine ​​prevents or minimizes paracetamol hepatotoxicity.

ICD-10 code

T39 Poisoning with non-opioid analgesics, antipyretics and antirheumatic drugs

Pathogenesis

Paracetamol is found in over 100 over-the-counter medications, including medications for children (capsules, tablets and syrups), as well as drugs used for coughs and colds. Many prescription drugs also contain paracetamol. In this regard, an overdose of paracetamol is common. The main toxic metabolite of paracetamol, N-acetyl-b-benzoquinoneimine, is produced by the liver cytochrome P450 enzyme system; detoxified in the liver by glutathione. Acute overdose depletes glutathione stores in the liver. As a result, N-acetyl-b-benzoquinoneamine accumulates, causing necrosis of hepatocytes, and damage to other organs (kidneys, pancreas) is possible. Theoretically, alcoholic liver disease and malnutrition may increase the risk of damage, since the state of the hepatocyte enzyme system causes an increased production of N-acetyl-β-benzoquinoneimine, and due to exhaustion (which is typical for alcoholics) leads to a decrease in glutathione stores. However, it is not clear whether the risk actually increases. Alcohol intake may be protective, as the P450 liver enzymes preferentially metabolize ethanol and, as a result, cannot produce the toxic N-acetyl-b-benzoquinoneimine.

For poisoning, an acute overdose of a total of > 150 mg / kg of body weight (about 7 g for adults) is needed during the day.

Chronic overdosage or repeated overdoses lead to liver damage in rare cases. Usually chronic overdose occurs due to the use of an unreasonably large amount of the drug for the treatment of pain, and not intentional poisoning.

Symptoms of paracetamol poisoning

Mild poisoning may be asymptomatic, or the symptoms are minimally expressed within 48 hours from the moment of taking the drug.

Acute single overdose of paracetamol

Clinical symptoms, passing 4 stages, include anorexia, vomiting, nausea, pain in the right hypochondrium. The activity of aspartate aminotransferase (ACT) and alanyl aminotransferase (ALT) may increase, and in severe poisoning, total bilirubin and MHO. An increase in ACT >1000 U/L is more likely to result from paracetamol poisoning than from chronic hepatitis or alcoholic liver disease. In this case, renal failure and pancreatitis are possible, sometimes without liver failure. After 5 days, liver damage either regresses or progresses to multiple organ failure, which is often fatal.

An overdose of paracetamol should be considered in all patients with non-accidental use of the drug, which may be a suicidal attempt, since overdose is characteristic of this. In addition, in the early stages, overdose symptoms are minimal, it is potentially fatal, but curable, and patients with impaired consciousness or after suicide may not report it.

The likelihood and severity of liver damage can be predicted by the amount of drug taken, or more accurately by its concentration in the blood. If the time of taking the drug is known, can the Ramack-Matthew nomogram be used to predict the severity of liver damage? if the time of taking the drug is unknown, the nomogram cannot be used. With a single acute overdose of the traditional or fast-acting form (absorbed 7-8 minutes faster) of paracetamol, its concentration is measured after 4 hours from the moment of administration and the values ​​are plotted on a nomogram. If the concentration is 150 mcg / ml (990 mmol / l), and there are no symptoms of intoxication, the risk of liver damage is very low. A higher concentration indicates the possibility of liver failure. In case of an overdose of prolonged paracetamol (which has 2 peak concentrations with an interval of 4 hours), its concentration is measured 4 hours after administration and again after 4 hours. Treatment is indicated if one of the indicators exceeds the parameters of the Rumack-Matthew line.

Chronic overdose of paracetamol

Symptoms may be absent or may resemble those of an acute overdose. The Ramack-Matthew nomogram is not used, but the likelihood of clinically significant liver failure can be assessed based on the activity of aminotransferases and the concentration of paracetamol in the blood. At normal ACT and ALT (10 mcg / ml and there is a possibility of liver damage, it is necessary to re-examine the activity of ACT and ALT during the day. If the enzyme activity is not increased during repeated measurement, the risk of liver failure is low, with an increase in activity, the development of liver damage can be assumed. Liver damage it is also necessary to assume in the case of initially high activity of aminotransferases, regardless of the concentration of paracetamol in the blood.

stages

Treatment of paracetamol poisoning

If the presence of paracetamol in the gastrointestinal tract is expected, activated charcoal is prescribed. The antidote for paracetamol poisoning is acetylcysteine. It is a precursor of glutathione and reduces paracetamol toxicity by increasing the hepatic glutathione stores and possibly by other mechanisms.

At acute poisoning acetylcysteine ​​is prescribed if the likelihood of liver damage is based on the magnitude of the dose of paracetamol or its concentration in blood plasma. The drug is most effective in the first 8 hours after poisoning.

In chronic poisoning, acetylcysteine ​​is prescribed for the first 24 hours, if liver damage is likely (ALT and ACT are not elevated, the concentration of paracetamol is slightly increased). If ALT and ACT are not elevated during a second (after 24 hours) study, the administration of acetylcysteine ​​is stopped. In the case of an increase in ACT and ALT, daily monitoring of fermentemia and continued therapy with acetylcysteine ​​are necessary until these indicators normalize. If liver damage is likely (especially with high transaminase activity on admission), a full course of acetylcysteine ​​therapy is carried out.

Acetylcysteine ​​is equally effective when administered intravenously and orally. The drug is administered intravenously as a continuous infusion. A loading dose of 150 mg/kg per 200 ml of 5% glucose solution or 0.9% sodium chloride solution is administered over 15 minutes; then a maintenance dose of 50 mg / kg in 500 ml of 5% glucose solution or 0.9% sodium chloride solution is administered over 4 hours; then 100 mg / kg in 1000 ml of 5% glucose solution or 0.9% sodium chloride solution is administered over 16 hours. In the treatment of children, dose adjustment is necessary to reduce the total volume of fluid administered; consultation with the Poison Control Center is recommended.

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Paracetamol is a well-known antipyretic. It is important to strictly observe the dosing regimen in order to avoid overdose. But if such a situation occurs, you need to know how to help.

Doctors from all over the world recommend taking paracetamol with an increase in body temperature. The medicine is really effective, but if the dosage is not observed, it can cause significant harm to the body, turning into a poison for both an adult and a child. The majority of the world's population does not even have an idea what will happen if you drink 10 tablets of paracetamol or take an overdose.

Paracetamol is an antipyretic. Helps with headaches and has a slight anti-inflammatory effect. The drug has a depressing effect on the cause of the fever. The absorption of the substances of the drug occurs in the upper intestine, then they enter the tissues of the body; their breakdown occurs in the liver.

Paracetamol can also be prescribed for back pain, toothache and headache, myalgia and neuralgia, arthralgia, algomenorrhea. The drug is recommended to be taken with an increase in body temperature, which was caused by colds, flu and other infectious diseases.

If you take a large amount of the drug, then health problems will be much worse than high fever. Why is this happening? 120 minutes after taking paracetamol orally, the drug begins to enter the bloodstream. The highest concentration is reached approximately 4 hours after ingestion.

To neutralize and remove chemicals from the body, the liver is engaged in the removal of a specially designed enzyme, which is called "glutathione". The enzyme works effectively only if the allowable rate of the drug has been adopted, and with a large number of chemicals in the body, “glutathione” cannot cope. Toxins begin to combine with liver protein, killing liver cells, which subsequently causes poisoning of the body.

In the process of metabolism, toxins enter every organ and all tissues, which leads to disruption of their functioning. Next comes acidosis (acidification of the blood). In the process of poisoning, all organs suffer, but most of all, the negative effect is on the liver, heart, pancreas, and central nervous system.

Dosage table

You can calculate a single dose for taking it yourself according to the formula: 60 mg * 1 kg of weight. But this form is valid for children and adults weighing up to 50 kg. The dosage is the same and must be observed, regardless of the form of release. Doctors always recommend reading the instructions to avoid overdose or side effects.

An overdose of the drug is divided into 4 stages:

Symptoms of intoxication

Intoxication can be determined by the first signs that begin to appear 2-3 hours after taking an overdose. Overdose symptoms include:

• Heaviness and pain in the region of the liver.
• Vomiting, nausea at the sight of food.
• Malaise and weakness throughout the body.

If you do not attach importance to the above symptoms and do not seek help, toxins will spread throughout the body. It will appear like this:

An overdose of the drug carries a great danger to the whole organism, but in the case when the dose was exceeded slightly, only symptoms of mild poisoning will appear. The average overdose in a large number of cases passes without symptoms and complications, even in children (depending on the condition immune system and other features of the body).

It is important to read the instructions for paracetamol, it says both about an overdose and how many pills you need to drink just to bring down the temperature. It is important to follow the recommendations so as not to end up in a hospital bed. It is recommended to take no more than 4 tablets per day for adults and 2 children. Taking more will start the poisoning process.

Packets of paracetamol are available with different contents active substances: 0.2 gr., 0.35 gr. and 0.5 gr. The daily dose should be no more than 4 grams; accordingly, if you take 10 tablets of the drug with active substances 0.2 and 0.35, then the permissible dosage will not be exceeded. If you eat 10 tablets, in which 0.5 gr. active substances, then signs of mild poisoning may appear.

After an overdose of paracetamol, the effects may differ depending on the age of the person. It also depends on the state of the immune system.

Adults

An overdose of medicine in adults is accompanied by severe complications. Treatment is carried out in a hospital for about 21 days, then home therapy is prescribed.

Important! Patients with an overdose of paracetamol who were able to save their lives develop liver failure.

Small children

In children, metabolic processes take place with peculiarities, for this reason they tolerate an overdose of paracetamol much easier than adults. Liver failure develops only in particularly difficult cases.

If symptoms of an overdose begin to appear, then you should immediately call an ambulance. Before the doctors arrive, you should do a gastric lavage: drink plenty of water and take activated charcoal at the rate of 1 tablet per 10 kilograms of weight. After the appearance of the first symptoms, it is necessary to introduce an antidote into the body within eight hours, namely acetylcestein. An antidote helps to remove toxins from the body.

Doctors prescribe:

You can die about 10 gr. drug (20 tablets of 0.5 g), taken once in combination with alcohol. If the body is weak, then 10 grams without alcohol will be enough. In a short time, death occurs when taking 20 gr. (40 tablets of 0.5 gr.) One-time. When intoxication is very strong, a person’s life cannot be saved even in intensive care.

When taking a lethal dose of paracetamol in tablets, organs gradually begin to fail (usually the liver), which leads to death. Basically, death occurs on the 5th day after a severe overdose.

In order not to get poisoned by the drug, you need to follow the recommendations of experts:

Reasons for abuse

There are few reasons for an overdose of the drug and these include:

1. Suicide.
2. Treatment with drugs containing paracetamol and paracetamol at the same time.
3. Treatment with paracetamol in the acute stage of liver disease.
4. The combination of alcohol with the drug.

It is worth noting that a large number of paracetamol overdoses occur due to suicide, but only 0.9% of the victims could not be saved.

Many try to ignore the first symptoms of an overdose of paracetamol, which can cause serious complications and even death. You must immediately consult a doctor.

Paracetamol (for Latin- "Paracetamol") is an organic compound that is a derivative of an aromatic amine (aniline), in which the hydrogen atom is replaced by a carboxylic acid residue. To date, Paracetamol is the best-selling drug with analgesic and antipyretic (anti-febrile, antipyretic) action. The widespread use of paracetamol is due not only to low cost and fairly high efficiency, but also to a low degree of toxicity compared to other drugs of the anilide group. The tool is sold without a prescription, so many people buy it without consulting a doctor when pain occurs. different localization and intensity. Uncontrolled use can not only cause serious side effects, but also cause an overdose, especially if a person is not limited to the minimum effective therapeutic dose and uses increased dosages of paracetamol without strong indications.

Description of the drug

Paracetamol is the main primary metabolite (decay product) of phenacetin, an unregistered and prohibited for sale in Russia in its pure form, a substance with a high degree of nephrotoxicity. In high doses, as well as with prolonged use, phenacetin can cause severe kidney failure and provoke the growth of tumor formations in the urinary tract.

In terms of structure and chemical properties paracetamol (in Europe, the drug is better known as Acetaminophen) is close to phenacetin, but has a number of advantages over its "predecessor", for example:

• has low toxicity and does not have a pronounced negative effect on the functioning of the kidneys (if the instructions are followed);
• rarely causes the formation of oxygen-containing metalloprotein forms of hemoglobin that are not able to bind oxygen and transport it to cells and tissues;
• when used in therapeutic doses, it is well tolerated;
• unlike phenacetin, paracetamol is approved for use in infants older than 1 month (in the form of suppositories and suspensions).

The drug effectively eliminates febrile syndromes by inhibiting the synthesis of prostaglandins (mediators of pain and inflammation) in the central nervous system, and also reduces the degree of their impact on the thermoregulatory center in the hypothalamus. As an anesthetic, the drug is most effective for migraine, arthritis, toothache, various dorsopathies, infectious diseases accompanied by hyperthermia and fever.

Can paracetamol poison you?

Paracetamol poisoning can occur for several reasons. The first and most important of them is an overdose. The causes of overdose may be long-term use (drugs from the anilide group are not recommended for use longer than 5 days) or a violation of the dosing regimen. This situation is typical for people suffering from chronic diseases prone to relapses and exacerbations. These can be pathologies of the musculoskeletal system, dental diseases, disorders of the autonomic and central nervous system etc. A person experiencing severe pain tries to stop it as soon as possible, for which he takes an increased dosage of paracetamol (usually this happens several times during the day).

Another common cause of poisoning is the combination with alcoholic beverages. Despite the fact that paracetamol is less toxic compared to phenacetin and other anilides, when interacting with ethyl alcohol, which is part of almost all alcoholic beverages, it can cause severe intoxication with impaired vital functions: respiratory, cardiac contractility, CNS functioning . If a person has already taken alcohol, if possible, refuse to take aniline derivatives or reduce the dose of the drug by 1.5-2 times.

Important! Signs of an overdose in a person may appear even if he did not violate the dosing regimen recommended in the instructions. This can happen if the patient ignored the existing contraindications.

For example, in severe liver diseases, taking (especially repeated) paracetamol can cause poisoning, since 96.9% of the substance is metabolized in the liver cells, and if there are disturbances in the functioning of this organ, the metabolic process will proceed several times slower, causing acute intoxication.

Dangerous dosage

For adults, a single dose of the drug is usually 500 mg (1 tablet). At severe pain Doubling the dose is allowed, but not more than two tablets at a time. It is necessary to take the drug separately from meals. Reception after a meal reduces the absorption of the active substance by almost 43.1%, which leads to a weakening of the analgesic and antipyretic effect and forced excess of the minimum effective therapeutic dose to achieve the desired result.

Information on how many tablets you need to take in order for an overdose or poisoning to occur is indicated in the official annotation. Dangerous doses are:

• 3 tablets at a time - an acute overdose occurs;
• 4-5 tablets or more - poisoning occurs;
• 8 tablets per day - severe poisoning occurs;
• 30 tablets per day - severe liver damage occurs;
• 40 tablets per day (more than 15 tablets at a time) - a high probability of death due to sudden cardiac arrest or depression of the respiratory center.

For example, tablets containing 500 mg of paracetamol (adult dosage) are indicated.

What dose can be dangerous for a child?

Paracetamol is the most prescribed drug for pain relief and hyperthermia in children from the age of one month. This medicine preferred by both pediatricians and doctors of narrow specialties due to the low degree of toxicity and gentle effect on gastrointestinal tract child. An overdose of paracetamol in children in most cases occurs due to the fault of the parents, who repeatedly give the medicine when high temperature without maintaining the recommended interval, which is at least 3-4 hours.

Symptoms of an overdose in a child can occur even after a single dose is exceeded, which is no more than 10-15 mg / kg (up to 4 times a day). If you find any of the possible signs of an overdose, it is important to immediately call an ambulance and provide first aid at home. A dangerous daily dose of paracetamol for children is 65-70 mg/kg.

Signs and symptoms

The most common symptoms of paracetamol drug intoxication include:

• pain and cramps in the abdomen (mainly spastic and cramping);
• skin blanching;
• changes from of cardio-vascular system(pulse disturbance, slow heart rate, falling blood pressure, shortness of breath);
• nausea and vomiting (vomit has a thick consistency and a rich white or milky hue);
• change in taste perception, the appearance of strong bitterness and a metallic taste in the mouth;
• painful constipation, false imperative urge to defecate;
• functional diarrhea;
• tremor of the limbs;
• pupil dilation;
• violation of motor coordination and speech disorder (extremely rare);
• yellowness of the skin and mucous membranes (with toxic liver damage).

In young children, symptoms may be manifested by frequent and profuse regurgitation of fetid masses of unnatural consistency with a pungent odor. The child may show great anxiety, refuse to breastfeed, and kick his legs. The abdomen is swollen, painful on palpation. Stool changes do not always occur, but more often proceed as constipation with preceding tenesmus.

Health care

The antidote of paracetamol is acetylcysteine ​​(a substance with antioxidant, mucolytic and expectorant effects). The total dose of acetylcysteine ​​is 300 mg per kilogram of the patient's body weight, which must be administered sequentially according to a certain scheme for 20 hours (that is, to provide emergency care takes less than a day). It is necessary to dilute the drug in a 5% glucose solution.

Scheme of administration of acetylcysteine ​​in paracetamol poisoning:

For obese persons (body weight over 110 kg), the dosage of acetylcysteine ​​is increased by 1.5 times, while the volume of the required glucose solution remains the same.

Consequences and complications

One of the most serious consequences of paracetamol poisoning is toxic liver damage, which occurs with prolonged use of the drug at an increased dosage. The main risk factors for damage to hepatocytes while taking paracetamol are disorders eating behavior, alcoholism, extreme exhaustion of the body, a long break between meals (for example, due to severe toothache). With regular use of alcoholic beverages in large doses, a person may induce liver enzymes, which in itself is a risk factor for hepatotoxic effects, and in combination with paracetamol, alcoholic beverages can extremely negatively affect the functioning of the liver system, as well as the functioning of the kidneys and urinary tract.

Among others possible consequences overdose can also be the following pathologies:

• heavy allergic reactions(including angioedema, laryngospasm, anaphylactic shock);
• hypochromasia (a group of anemias for which the color index of blood, due to a lack of normal hemoglobin, is less than 0.8 units);
• methemoglobinemia (a disease in which the level of methemoglobin in the blood reaches 1% or more);
• tubulointerstitial nephritis;
• kidney failure.

In extremely severe cases (when using more than 40 tablets per day), death is possible, especially if a person combined the use of paracetamol with alcohol.

Paracetamol is an inexpensive, effective and, when used correctly, fairly safe drug with antipyretic and analgesic effects. In case of symptoms of an overdose, it is necessary to carry out specific therapy, which consists in the infusion administration of an antidote (acetylcysteine). Further treatment includes mandatory observation in the hospital for at least 3 days, supportive and symptomatic therapy.