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