Characteristics of Patients with Paracetamol Overdose and Principal Risk Factor for Severe Hepatotoxicity

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ฮาริส มะซัน
มาโนช หล่อตระกูล
สุดาวรรณ จุลเกตุ


Objectives : To study characteristics and risk factors for severe hepatotoxicity among paracetamol
overdose patients who were treated at Ramathibodi Hospital from 2007 to 2016.
Methods : This is a retrospective descriptive study of patients who were diagnosed with
“paracetamol overdose” (ICD-10: T391) between 1 January 2007 and 31 December 2016. Data
were collected from Patients’ Record and Medical Informatics Division, Ramathibodi Hospital.
Results : A total 105 patients were diagnosed with paracetamol overdose. The majority of patients
were female students between the age of 21–39 with non-marital status and holding a bachelor’s
degree or higher. The motivation for paracetamol overdose was to commit suicide and self-harm
(49.42%), driven by relationship problems (67.44%) and most of them had suicidal attempts before
(66.67%). Most overdoses were impulsive attempts (91.95%) with no previous history of psychiatric
illnesses (84.95%). 58.25 percent of them were diagnosed with adjustment disorders. Laboratory
tests indicating severe hepatotoxicity were AST, ALT, PT, PTT and INR, whereas ALP played
insignificant role. Paracetamol blood level did not correlate with the severity of hepatotoxicity. The
major risk for hepatotoxicity is the time between paracetamol ingestion and visiting the emergency
room. Patients who visited the emergency room later than 8 hours after paracetamol ingestion
had a 20.9 time higher risk for hepatotoxicity compared to those who visited earlier (95% CI
5.476-79.682, p-value < 0.001). The hospitalization period of patients with severe hepatotoxicity
is significantly higher than those without severe hepatoxicity.
Conclusion : Most cases of paracetamol overdose were impulsive acts of self-harm. The chance
of developing severe hepatotoxicity is low if patients came earlier after drug ingestion. It is crucial
to promote social awareness of the importance of receiving prompt treatment after paracetamol
overdose as this helps reduce the rate of severe hepatoxicity. It will also reduce unnecessary uses
of resources, including expenses, time, and medical personnel.


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มะซัน ฮ., หล่อตระกูล ม., & จุลเกตุ ส. (2019). Characteristics of Patients with Paracetamol Overdose and Principal Risk Factor for Severe Hepatotoxicity. Journal of the Psychiatric Association of Thailand, 64(2), 127–138. Retrieved from
Original Articles


World Health Organization. Suicidal data 2018. 2018 [cited 15 December 2018]. [Available from: prevention/suicide/suicideprevent/en/

Department of Mental Health, Ministry of Public Health. Suicide rate per 1000,000 populations 2016. 2016 [cited 15 December 2018]. Available from: download/view.asp?id=170

Ajdacic-Gross V, Weiss MG, Ring M, Hepp U, Bopp M, Gutzwiller F, et al. Methods of suicide: international suicide patterns derived from the WHO mortality database. Bull World Health Organ 2008; 86: 726-32.

Elnour AA, Harrison J. Lethality of suicide methods. Inj Prev 2008;14:39-45.

Williams SC, Schmaltz SP, Castro GM, Baker DW. Incidence and Method of Suicide in Hospitals in the United States. Jt Comm J Qual Patient Saf 2018; 44: 643-50.

Kolves K, McDonough M, Crompton D, de Leo D. Choice of a suicide method: Trends and characteristics. Psychiatry Res 2018; 260: 67-74.

Aguilera P, Garrido M, Lessard E, Swanson J, Mallon WK, Saldias F, et al. Medication overdoses at a public emergency department in Santiago, Chile. West J Emerg Med 2016; 17: 75-80.

Manthripragada AD, Zhou EH, Budnitz DS, Lovegrove MC, Willy ME. Characterization of acetaminophen overdose-related emergency department visits and hospitalizations in the United States. Pharmacoepidemiol Drug Saf 2011; 20: 819-26.

Kapur N, Turnbull P, Hawton K, Simkin S, Sutton L, Mackway-Jones K, et al. Self-poisoning suicides in England: a multicentre study. QJM 2005; 98: 589-97.

El Majzoub I, El Khuri C, Hajjar K, Bou Chebl R, Talih F, Makki M, et al. Characteristics of patients presenting post-suicide attempt to an Academic Medical Center Emergency Department in Lebanon. Ann Gen Psychiatry 2018; 17: 21.

Kweon YS, Hwang S, Yeon B, Choi KH, Oh Y, Lee HK, et al. Characteristics of drug overdose in young suicide attempters. Clin Psychopharmacol Neurosci 2012; 10: 180-4.

Gazzard BG, Davis M, Spooner J, Williams R. Why do people use paracetamol for suicide? Br Med J 1976; 1: 212-3.

Gazzard BG, Davis M, Spooner JB, Williams RS. Why paracetamol? J Int Med Res 1976; 4: 25-8.

Gunnell D, Murray V, Hawton K. Use of paracetamol (acetaminophen) for suicide and nonfatal poisoning: worldwide patterns of use and misuse. Suicide Life Threat Behav 2000; 30: 313-26.

Hawton K, Bergen H, Simkin S, Arensman E, Corcoran P, Cooper J, et al. Impact of different pack sizes of paracetamol in the United Kingdom and Ireland on intentional overdoses: a comparative study. BMC Public Health 2011; 11: 460.

Hawton K, Townsend E, Deeks J, Appleby L, Gunnell D, Bennewith O, et al. Effects of legislation restricting pack sizes of paracetamol and salicylate on self poisoning in the United Kingdom: before and after study. BMJ 2001; 322: 1203-7.

Sarchiapone M, Mandelli L, Iosue M, Andrisano C, Roy A. Controlling access to suicide means. Int J Environ Res Public Health 2011; 8: 4550-62.

Krenzelok EP. The FDA Acetaminophen Advisory Committee Meeting - what is the future of acetaminophen in the United States? The perspective of a committee member. Clin Toxicol (Phila) 2009; 47: 784-9.

Gulmez SE, Larrey D, Pageaux GP, Bernuau J, Bissoli F, Horsmans Y, et al. Liver transplant associated with paracetamol overdose: results from the seven-country SALT study. Br J Clin Pharmacol 2015; 80: 599-606.

Yoon E, Babar A, Choudhary M, Kutner M, Pyrsopoulos N. Acetaminophen-Induced hepatotoxicity: a comprehensive update. J Clin Transl Hepatol 2016;4:131-42.

Suppapitiporn S, Suppapitiporn S. Attempted suicide by acetaminophen ingestion. Chulalongkorn Medical Journal 2003; 47: 713-25.

Narongchai P, Narongchai S. Paracetamol overdose in suicidal attempt patients. J Med Assoc Thai 2004; 87: 423-6.

Chatchaichukiat P. Characteristic of in-patient of paracetamol overdose in ramathibodi hospital [Dissertation]. Bangkok: Ramathibodi Hospital, Mahidol University; 2006.

Schmidt LE. Age and paracetamol self-poisoning. Gut 2005; 54: 686-90.

Gyamlani GG, Parikh CR. Acetaminophen toxicity: suicidal vs. accidental. Crit Care 2002; 6: 155-9.

Kweon YS, Hwang S, Yeon B, Choi KH, Oh Y, Lee HK, Lee CT, Lee KU. Characteristics of drug overdose in young suicide attempers. Clin Psychopharmacol Neurosci 2012; 10: 180-4.

Hawton KW, Mistry H, Hewitt J, Kingsbury S, Roberts D, Weitzel H. Paracetamol self-poisoning characteristics, prevention and harm reduction. Br J Psychiatry 1996; 168: 43-8.

Iqbal M, Cash WJ, Sarwar S, McCormick PA. Paracetamol overdose: the liver unit perspective. Ir J Med Sci 2012; 181: 439-43.

Sheen CL, Dillon JF, Bateman DN, Simpson KJ, Macdonald TM. Paracetamol toxicity: epidemiology, prevention and costs to the health-care system. QJM 2002; 95: 609-19.

O’Rourke M, Garland MR, McCormick PA. Ease of access is a principal factor in the frequency of paracetamol overdose. Irish journal of medical science 2002; 171: 148-50.

Giannini EG, Testa R, Savarino V. Liver enzyme alteration: a guide for clinicians. CMAJ 2005; 172: 367-79.

Palta S, Saroa R, Palta A. Overview of the coagulation system. Indian J Anaesth 2014; 58: 515-23.

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