Why an overdose of paracetamol can be fatal

Why an overdose of paracetamol can be fatal

Above 4 grams per day in adults, the paracetamol may be toxic to the liver, and even more so if it is associated with alcohol intake.

Above 4 grams per day in adults, paracetamol may be toxic to the liver, and more if it is associated with the taking of alcohol.
Last December, France was indignant at the death of Naomi Musenga, a Strasbourgeoise of 22 whose distress call had been neglected by a regulator of Samu. Wednesday, the light was finally made on the circumstances of the death of the young woman by the Strasbourg prosecutor in charge of the case, Yolande Renzi.

In a statement, Mrs. Renzi said that the death would be the result of "paracetamol intoxication absorbed by self-medication over several days". "The evolutionary destruction of the cells of his liver brought a failure of all his organs leading quickly to his death," said the prosecutor.

In case of excess paracetamol, the purifying capacities of the liver are exhausted and a potentially fatal fulminant hepatitis can occur

Of all the painkillers, paracetamol is the reference one for treating headaches, sore throat or fever during a cold because it is the one that causes the least side effects. Also known as Doliprane, Efferalgan or Dafalgan, this over-the-counter pain reliever is the most widely prescribed and sold in the world. Although it is very rare that this drug causes undesirable effects when used properly, an overdose of paracetamol exposes itself to serious disorders. He is also the second drug behind calls to the poison control center in Paris, behind bromazepam (an anxiolytic).

Above 4 grams per day in adults weighing more than 50 kilos, paracetamol may be toxic to the liver and, more rarely, to the kidneys. This organ is responsible for detoxifying this drug. However, in case of excess paracetamol, the purifying capacities of the liver are exhausted and a potentially fatal fulminant hepatitis can occur. This risk is increased if this overdose is added alcohol consumption. In fact, "the alcohol is detoxicated by the liver according to the same mechanism as paracetamol", as explained by Prof. François Chast, pharmacist at the Necker Hospital (Paris), in his book The drugs in 100 questions (Ed Tallandier).

Treatments Exist

Paracetamol intoxication occurs within 24 hours after ingestion with nausea and vomiting, sometimes accompanied by sweating and lethargic status. If pains appear on the right side of the belly, it is a sign that the liver is affected. In this case, the organ can be gradually destroyed within 3 to 4 days. This leads to severe liver failure, hemorrhage, cerebral edema and encephalopathy (inflammation of the brain), which can lead to death in the absence of a liver transplant.

Before this stage is reached, it is possible to prevent complications by administering activated charcoal within one hour of overdose. The standard treatment remains acetylcysteine, which has an optimal effect when given within 8 to 10 hours after ingestion of the painkiller.

Never more than 4 grams per day in adults

To avoid these complications, care should be taken not to exceed the dosage of the drug. This is fixed according to the weight of the patient, not his age. In adults and children weighing more than 50 kilograms, the dosage is 500 mg to 1 gram per dose, repeat if necessary after a delay of at least four hours, taking care not to exceed 4 grams in 24 hours. In persons under 50 kg, do not exceed 10 to 15 mg per kilogram per dose, spaced at least 4 hours apart and no more than 60 mg per kilogram in 24 hours.

"It is recommended not to exceed 3 grams but in case of severe pain, it can go up to 4 grams, confirms Professor Bernard Bégaud, pharmacologist at the University of Bordeaux. But these are special cases, routinely do not go up to 4 grams. For the very old and the alcohol dependent, three grams are probably already too much in the liver ". In some people, it is recommended not to exceed more than 3 grams of paracetamol per day: in case of heavy consumption of alcohol, liver disease, prolonged fasting, anorexia or malnutrition and in people elderly.

Paracetamol can be taken punctually during pregnancy because it presents no risk for the mother and the child, unlike anti-inflammatory drugs (ibuprofen, aspirin). Likewise, it can be used safely by breastfeeding women.

Le Figaro.fr Health