Letter [Paracetamol (acetaminophen) poisoning - No need to change current guidelines to accident departments] [Correspondence]

Paracetamol is an effective, simple analgesic that is well tolerated by adults and children at therapeutic doses. In many countries it is available without prescription. Unfortunately, its ready availability is associated with episodes of poisoning that prompt 3.3% of inquiries to US regional poisons centres,1 10% of inquiries to the UK National Poisons Information Service,2 and up to 43% of all admissions to hospital with self poisoning in the United Kingdom.3 In the United States paracetamol alone accounted for 4.1% of deaths from poisoning reported to American poisons centres in 1997.1 Most deaths are associated with deliberate self poisoning, but therapeutic misadventures do occur rarely, in both adults and children..

Managing self poisoning: Gastric lavage is perhaps more important in developing countries

In their clinical review of recent advances in the management of self poison­ing, Jones and Volans briefly discuss gastric lavage and state: “many clinical toxicologists rarely use this method now.”1 The impres­sion given could support the abandonment of gastric lavage. This could be particularly deleterious in developing countries

Management of self poisoning

Around 15%­20% of the workload of medical units and 10% of the workload of accident and emergency departments in the United Kingdom are due to self poisoning.1 2 Episodes of self poisoning in the United Kingdom continue to rise, particularly in young men, and alcohol is often taken with the overdose.2 In general the severity of poisoning has diminished over the past 10 years with the introduction of safer drugs, such as newer serotonin reuptake inhibitors, but the total number of deaths from poisoning in the United Kingdom remains steady at 4000 per year, and the commonest cause of death by poisoning is carbon monoxide.2 3 This article highlights several specific advances in the management of poisoning over the past two or three years