title: Liver unit admission following paracetamol overdose with concentrations below current UK treatment thresholds.
abstract: BACKGROUND
  It has been suggested that current UK thresholds for treating paracetamol overdose should be reduced, following case reports of patients developing fatal liver failure after presenting with paracetamol concentrations below these thresholds.
  
  
  OBJECTIVE
  To determine the frequency of severe liver dysfunction following paracetamol overdose when paracetamol concentrations are below current UK antidote thresholds.
  
  
  METHODS
  Retrospective case note review.
  
  
  METHODS
  Details were collected from all patients admitted to liver transplant units in Newcastle and Edinburgh with paracetamol-induced hepatotoxicity.
  
  
  RESULTS
  Of 696 patients admitted to the two liver units following paracetamol overdose, 14 presented between 4 and 15 h after overdose with paracetamol concentrations below current UK treatment thresholds (estimated annual population rate 0.15/million person-years). Over the period of study, >100 000 presentations with paracetamol overdose would be expected in the catchment populations for these liver units.
  
  
  CONCLUSIONS
  In view of the rarity of this event, this research does not suggest a need to lower the current thresholds for antidotal treatment.
authors.affiliation: Wolfson Unit of Clinical Pharmacology, School of Clinical and Laboratory Sciences, University of Newcastle, Newcastle upon Tyne NE2 4HH.
authors.forename: C
authors.initials: C
authors.lastname: Beer
authors.forename: N
authors.initials: N
authors.lastname: Pakravan
authors.forename: M
authors.initials: M
authors.lastname: Hudson
authors.forename: L T
authors.initials: LT
authors.lastname: Smith
authors.forename: K
authors.initials: K
authors.lastname: Simpson
authors.forename: D N
authors.initials: DN
authors.lastname: Bateman
authors.forename: S H L
authors.initials: SH
authors.lastname: Thomas
mesh_terms: D000082:Acetaminophen / Q000506:poisoning*; D000111:Acetylcysteine / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000506:poisoning*; D000931:Antidotes / Q000627:therapeutic use; D062787:Drug Overdose / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D017093:Liver Failure / Q000139:chemically induced* / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D018712:Analgesics, Non-Narcotic; D000931:Antidotes; D000082:Acetaminophen; D000111:Acetylcysteine