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Epidemiology, management and outcome of paracetamol poisoning in an inner city emergency department

Benger, J.; Caroll, R.; Carroll, R.; Benger, Jonathan; Bramley, K.; Williams, S.; Griffin, L.; Potokar, J.; Gunnell, David


J. Benger

R. Caroll

R. Carroll

Jonathan Benger

K. Bramley

S. Williams

L. Griffin

J. Potokar

David Gunnell


Background: Paracetamol poisoning accounts for just under half of all self-poisoning cases that present to hospitals in England. Treatment with acetylcysteine is routine, yet recommendations regarding its use vary internationally and have recently been revised in England and Wales. Methods: Data on all cases of paracetamol poisoning presenting to an adult inner city emergency department between May 2011 and April 2012 were prospectively collected using the Bristol Self-harm Surveillance Register. Results: Paracetamol overdoses accounted for 44% of adult self-poisoning cases. A quarter (26.9%) of patients required treatment with acetylcysteine and it was estimated that recent changes in treatment guidelines would increase that proportion to 32.6%. Paracetamol concentration was positively associated with the risk of any adverse reaction to acetylcysteine. 22.5% of patients experienced anaphylactoid reactions to acetylcysteine. There was no clear evidence of an association between risk of anaphylactoid reaction and blood paracetamol levels. Patients presenting with blood paracetamol levels greater than 200 mg/L at 4 h post-ingestion were at greater risk of repeat self-harm (HR 2.17, 95% CI 1.11 to 4.21, p=0.033). Discussion: The recent changes in UK treatment guidelines are expected to increase the proportion of our population requiring acetylcysteine by 5.7%. We found no clear evidence that risk of anaphylactoid or more general adverse reaction to acetylcysteine was increased in patients presenting with lower blood paracetamol concentrations. Blood paracetamol level was highlighted as a potentially useful clinical indicator for risk of repeat self-harm.


Benger, J., Caroll, R., Carroll, R., Benger, J., Bramley, K., Williams, S., …Gunnell, D. (2015). Epidemiology, management and outcome of paracetamol poisoning in an inner city emergency department. Emergency Medicine Journal, 32(2), 155-160.

Journal Article Type Article
Publication Date Jan 1, 2015
Journal Emergency Medicine Journal
Print ISSN 1472-0205
Electronic ISSN 1472-0213
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 32
Issue 2
Pages 155-160
Keywords epidemiology, paracetamol, poisoning, inner city, emergency department
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