title: Characterisation and outcomes of adult patients with paracetamol overdose presenting to a tertiary hospital in Singapore.
abstract: BACKGROUND
  Paracetamol is the most common pharmaceutical agent implicated in toxic exposure in Singapore. This study aimed to describe the characteristics of paracetamol overdose in the adult population managed at a tertiary healthcare facility in Singapore.
  
  
  METHODS
  Medical records of adult patients hospitalised with a diagnosis of paracetamol overdose at National University Hospital, Singapore, over a three-year period from January 2011 to December 2013 were retrospectively reviewed.
  
  
  RESULTS
  A total of 177 patients had paracetamol overdose. The median age was 25 years, with a significant female predominance (71.2%). Intentional ingestion accounted for the majority (76.8%) of cases. The median dose of paracetamol ingested was 10 (interquartile range 8-15) g. Among patients who reported ingesting more than 10 g, 46.5% perceived the overdose as non-lethal. N-acetylcysteine was administered in 76.3% of patients, among whom 24.4% experienced an anaphylactoid reaction. Of the 10 (5.6%) patients who had severe hepatotoxicity, 2 (1.1%) developed acute liver failure. Most patients had resolving transaminases at discharge and none required liver transplantation. The median length of hospitalisation was three days. There were no fatalities.
  
  
  CONCLUSIONS
  Paracetamol overdose occurred predominantly in young adults with intentional ingestion, suggesting that preventive measures targeted at promoting public awareness may not suffice. However, the perceived lack of lethality by many patients who ingested potentially toxic amounts of paracetamol reflects a certain knowledge gap. Healthcare providers should proactively educate consumers on the proper use of paracetamol and the consequences of its overdose.
authors.affiliation: Department of Pharmacy, Tan Tock Seng Hospital, Singapore.
authors.forename: Christina Jiun-Yu
authors.initials: CJ
authors.lastname: Tan
authors.affiliation: Department of Pharmacy, National University of Singapore, Singapore.|Department of Pharmacy, National University Hospital, Singapore.
authors.forename: Grant E
authors.initials: GE
authors.lastname: Sklar
mesh_terms: D000082:Acetaminophen / Q000506:poisoning*; D000111:Acetylcysteine / Q000494:pharmacology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000517:prevention & control; D062787:Drug Overdose / Q000628:therapy*; D005260:Female; D006801:Humans; D008099:Liver / Q000187:drug effects; D017114:Liver Failure, Acute / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012846:Singapore; D013406:Suicide, Attempted; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000082:Acetaminophen; D000111:Acetylcysteine
keywords: acetaminophen; adult; drug overdose; liver failure; paracetamol