Asia Pacific Journal of Medical Toxicology

Acute Paracetamol Toxicity: A Study of Severity Assessment and Management at Alexandria Poison Control Center

Document Type : Original Article

Authors

Manal Hassan Abdel El-Aziz 1
Riham Ali Abdelhafeez Elkassass 1
Hanaa Saeed Elhoshy 2
Nourhan Mohamed Saeed 1

1 Department of forensic medicine and clinical toxicology, Faculty of Medicine, Alexandria University, Alexandria, Egypt

2 Department of medical education, Faculty of Medicine, Alexandria University, Alexandria, Egypt

https://doi.org/10.22038/apjmt.2025.89455.1524
Abstract
Background: Paracetamol poisoning is a common cause of drug-induced liver injury, especially due to its widespread availability. This study evaluates the frequency, clinical presentation, severity, and treatment outcomes of acute paracetamol toxicity cases at Alexandria Poison Control Center (APC) over six months.
Methods: This prospective study included 75 patients admitted to the APC with acute paracetamol overdose between July and December 2023. Data collected included demographics, exposure history, clinical examination findings, laboratory results, treatment protocols, and outcomes. Poison Severity Score (PSS) was used to assess toxicity severity. Statistical analyses examined associations between clinical and laboratory variables and patient outcomes.
Results: Of the patients, 74.7% were female, and 61.3% were adults. Suicide attempts accounted for 76% of cases. Clinical symptoms were predominantly gastrointestinal, with 48% reporting vomiting and 37.3% experiencing abdominal pain. The majority(72%) of cases were classified as minor toxicity based on PSS, while 8% were moderate, and only 1.3% were severe. Most patients were presented within 24 hours, with a mean hospital stay of 1.27 days. Liver enzyme elevation and INR correlated with prolonged hospital stay and higher PSS scores. All patients received N-acetylcysteine (NAC), with recovery observed in all cases and no fatalities.
Conclusion: Prompt administration of NAC, based on estimated toxic dose, proved effective in managing paracetamol toxicity, with all patients achieving full recovery. The study highlights the need for early intervention and underscores the role of demographic and social factors in overdose patterns. These findings support current treatment protocol and emphasize the need for preventive strategies, especially addressing intentional overdose.

Keywords

Acetaminophen Poisoning
acetaminophen toxicity
Acetylcysteine
liver injury
Poison Severity Score
Subjects
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Asia Pacific Journal of Medical Toxicology
Volume 14, Issue 3
Summer 2025
Pages 92-101

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