Paracetamol overdose is one of the leading causes of acute liver failure. Adults can usually take one or two 500mg tablets every 4-6 hours, but shouldn't take more than 4g (eight 500mg tablets) in the space of 24 hours.
In general, paracetamol poisoning is associated with hepatotoxicity and very rarely with renal impairment in the absence of significant hepatic impairment. Paracetamol poisoning associated with renal impairment is rare, and it is mostly associated with hepatotoxicity.
However, repeatedly taking more than the recommended dose or overdosing on paracetamol can cause serious injury to the liver and even death. The recommended maximum dose of paracetamol for an adult (or child over 12 years) is 4g in any 24-hour period (equivalent to 8 x 500mg tablets).
Untreated paracetamol poisoning may cause varying degrees of liver injury over the 2 to 4 days following ingestion, including fulminant hepatic failure.
These symptoms include feeling tired, abdominal pain, or nausea. This is typically followed by absence of symptoms for a couple of days, after which yellowish skin, blood clotting problems, and confusion occurs as a result of liver failure.
Acetaminophen (paracetamol), when taken in reduced doses (maximum 2–3 grams per day), is generally considered to be the safest pain relief option for your liver.
While acute liver injury can occur when used at or below the recommended daily maximum dose (4000 mg)[4], paracetamol toxicity is often the result of ingestion of paracetamol over this maximum dose.
Paracetamol in high single doses (typically 15 g or more) causes liver injury through a toxic metabolite, NAPQI (N-acetyl-p-benzoquinone imine). Alcohol consumption and possibly starvation induce cytocrome P-450 and therefore increase NAPQI synthesis.
The symptoms of acute liver failure caused by a paracetamol overdose include: A yellow colour to your eyes or skin (jaundice) Low blood sugar. Sweating.
Adults can usually take 1 or 2 tablets (500mg) every 4-6 hours, but shouldn't take more than 4g (8 x 500mg tablets) in the space of 24 hours.
It's safe to take paracetamol regularly for many years, as long as you do not take more than the recommended dose.
Taking 1 or 2 extra tablets is unlikely to harm you. Do not take more than 8 tablets in 24 hours. Taking too much paracetamol can be dangerous and you may need treatment.
Based on the dose of paracetamol ingested (mg/kg body weight): Less than 150 mg/kg - unlikely. More than 250 mg/kg - likely. More than 12 g total - potentially fatal.
Paracetamol is a common painkiller that is normally safe. If you take more than the recommended amount (an overdose), it can harm the liver, and occasionally the kidneys.
The liver is very resilient and capable of regenerating itself. Each time your liver filters alcohol, some of the liver cells die. The liver can develop new cells, but prolonged alcohol misuse (drinking too much) over many years can reduce its ability to regenerate.
The maximum dose within a 24-hour period must never be exceeded. Paracetamol overdose is one of the leading causes of acute liver failure. Adults can usually take one or two 500mg tablets every 4-6 hours, but shouldn't take more than 4g (eight 500mg tablets) in the space of 24 hours.
In severe cases, liver failure means the person will need a liver transplant, or they won't survive. Paracetamol is the leading cause of acute liver failure in the Western world.
Reversing liver damage Liver Basics
For example, an overdose of acetaminophen (Tylenol) can destroy half of a person's liver cells in less than a week. Barring complications, the liver can repair itself completely and, within a month, the patient will show no signs of damage.
Get medical help right away if you take too much acetaminophen (overdose), even if you feel well. Overdose symptoms may include nausea, vomiting, loss of appetite, sweating, stomach/abdominal pain, extreme tiredness, yellowing eyes/skin, and dark urine.
Acetaminophen remains the drug of choice for occasional use in patients with kidney disease because of bleeding complications that may occur when these patients use aspirin.
Paracetamol can be taken on an empty stomach, while it is best to take ibuprofen with food, or soon after. Abuse of paracetamol can cause damage on your liver, while abuse of ibuprofen can cause damage to your stomach or liver. It's safer to take paracetamol if you are pregnant than ibuprofen.
The only specific treatment for most cases of liver damage caused by taking a drug is to stop taking the drug that caused the problem.
Pain is common in patients with liver disease and is difficult to manage. Pain has been found in up to 82% of patients with cirrhosis and is chronic in over half of patients [1•–3].
Organ failure
Scientists at the University of Edinburgh studied the impact of paracetamol on liver cells in human and mouse tissue, and tests showed that in certain settings paracetamol can damage the liver by harming vital structural connections between adjacent cells in the organ.