Non-opioid analgesic poisoning.

Since the first cases of severe and fatal liver damage were reported in 1966,1,2 overdose of paracetamol has become the cause of 100–200 deaths in the UK each year.3 Paracetamol toxicity remains the leading cause of fulminant hepatic failure in the UK and is a common reason for liver transplantation.4,5 Knowledge of the toxic mechanism (Fig 1) has led to effective antidotes which provide substrates for increased glutathione production. Intravenous acetylcysteine (Parvolex®) is the treatment of choice in the UK. (Methionine is an oral alternative7 that can be considered only within the first 12 hours of overdose.) Although treatment of acute paracetamol overdose is well defined, decisions are complicated by late presentation, staggered overdoses and marked variation in individual susceptibility (Table 1).