By Sharon, Donna, Gill, Catherine
• Paracetamol was not widely used as an
analgesic until the 1950’s, and is from a group
of drugs known as non-opiod analgesics.
• It is kept in the home to relieve mild bouts of
pain and reduce fever.
• One of the primary advantages of paracetamol
is that it does not cause stomach upset or
bleeding problems (BMA, 2004).
• Taken correctly it is one of the safest over the
counter drugs, and is suitable for children as
well as adults.
• In oral preparation it is available in tablet,
capsule, or liquid suspension form.
• It is available in suppository form administered
• It can also be given IV
• The adult dosage is up to a maximum of 4g in 24
• Paracetamol is available to buy in most
convenience stores, supermarkets, drug stores
• It is also available combined with other products
• Cold and Flu preparations such as day nurse,
night nurse, and lemsip.
• Other combined preparations include co-
codamol, co-dydromol, anadin extra, and others.
• In 1998 the government introduced laws to
reduce the availability of paracetamol to the
• This legislation reduced the number of
paracetamol tablets that members of the public
are able to purchase at one time, with the aim
that restrictions would reduce the severity of
• An individual whom has ingested large amounts
of paracetamol may, in the early stages display
no clinical signs other than emotional distress or
• Paracetamol is the most common substance
used for self poisoning in the UK
• Between the years of 1981-1993 the incidence
of overdose increased by 400%.
Action and Metabolism
• Paracetamol is rapidly absorbed by the liver,
within 2 hrs, although the liver is the primary
organ damaged other organs such as the kidney
may also be damaged
• Paracetamol is metabolised in the liver.
• (NAPQI) is the end product of ingested
paracetamol, this metabolite is potentially
damaging to the liver.
• In normal doses of paracetamol NAPQI is
inactivated by hepatic glutahoine and this
substance is then excreted by the renal system
• However following an overdose the pathway is
blocked and NAPQI binds to the hepatocytes
leading to hepatotoxicity.
• This process leads to liver dysfunction and
• In the UK the preferred treatment for paracetamol
poisoning involves the use of IV N-acetylcysteine
• An alternative treatment for the management of
paracetamol poisoning is the use of methionine which is
used if Parvolex is not available or the patient can not
• A gastric lavage is performed to reduce the level of
paracetamol still to be absorbed by the stomach.
• Activated charcoal is also given as an oral preparation
which is shown to decrease absorption through the gut
• It is suggested that both the lavage and charcoal be
given within I hour of overdose
• As with every patient assessment the A, B, C, D, E,
framework should be used.
• Because hepatic and renal function could be
comprimised it is important to be alert to early
signs of damage
• Vital signs should be continuously monitored as
should blood glucose levels and fluid balance,
however in cases of paracetamol poisoning it is
not unusual to find that vital signs are unaffected
in the early stages.
• Blood samples should also be taken to
determine liver and renal function, including
paracetamol levels in the blood.
• It is important for the nurse to provide valuable
emotional support, especially with those patients
which have taken paracetamol to attempt self
• These patients may experience feelings of guilt
and shame, therefore it is important to interact in
a respectful and non judgmental manner.