[Paracetamol poisonings in Norway 1990-2001].
BACKGROUND
After the introduction of new regulations in 1981 and 1990 in Norway, over-the-counter sales of paracetamol and acetylsalicylic acid have been limited to 10 grams. From 1990 the sale of paracetamol has increased dramatically; that of acetylsalicylic acid has accordingly been reduced. We have investigated the morbidity and mortality from overdoses of analgesics, especially paracetamol, in the period 1990-2001.


METHODS
We collected data from the inquiries received by the National Poisons Information Centre in Norway. Data on hospital admissions and deaths have been recorded from the Norwegian Patient Register. These data have also been used to collect anonymous case records from all patients who died following intake of paracetamol. We also sent questionnaires to 57 hospital departments in a survey of deaths from paracetamol poisoning.


RESULTS
Calls concerning paracetamol poisonings to the National Poisons Information Centre doubled to about 400 calls per year over the period. In 30% of cases serious poisoning was suspected. Hospital admissions diagnosed primarily as analgesic poisoning increased from 848 to 1162. On average, 52% of poisonings were caused by paracetamol, 13% by opioids, 5% by acetylsalicylic acid; in 27% the analgesic involved was not specified. 59 deaths were diagnosed as poisoning from analgesics as primary cause, 13 of them due to paracetamol, 26 to opioids, 2 to acetylsalicylic acid; in 18 cases the analgesic involved was not specified. The questionnaires gave insignificant additional information.


CONCLUSIONS
The number of paracetamol poisonings has increased since 1990 in accordance with the dramatic increase in sales of paracetamol in Norway. Although the mortality of paracetamol poisoning is low (1-2 deaths annually), it represents the most critical poisoning problem among non-opioid analgesics. It is important to monitor the morbidity and mortality of paracetamol poisoning, as new regulations introduced from 2003 will increase the availability of paracetamol and other selected non-opioid analgesics.
Bøe
Grethe Helen
GH
Avdeling for giftinformasjon (Giftinformasjonen), Sosial- og helsedirektoratet, Postboks 8189 Dep, 0034 Oslo. g.h.boe@shdir.no
Haga
Christian
C
Andrew
Erik
E
Berg
Knut Joachim
KJ
D000082:Acetaminophen / Q000506:poisoning*; D000293:Adolescent; D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000506:poisoning*; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D004366:Nonprescription Drugs; D009664:Norway / Q000453:epidemiology; D011039:Poison Control Centers / Q000706:statistics & numerical data; D011041:Poisoning / Q000401:mortality*; D012042:Registries
D018712:Analgesics, Non-Narcotic; D004366:Nonprescription Drugs; D000082:Acetaminophen