Paracetamol Overdose - Kindly Help

Approx 52 hours ago, my friend (male, age 40 years) took 30 tablets of 500mg Paracetamol. He went to a hospital in 90 minutes. He was provided saline water orally multiple times (approx one and half litres) to induce vomiting, he vomited multiple times, initially noticeable quantity of Paracetamol particles were observed and finally the vomit was clear. He was under observation of 4 hours with no other medication or tests. During that time he experienced feeling chill, slightly feverish. He left the hospital and vomited once more which contained bile. On that day he had only liquids without issues, tried to eat a biscuit but vomited it. There were no other symptoms. Next day morning (24 hrs) his excretion (stools) were blackish and stinky, during day 2 (24 hrs onwards) he was able to eat light food without any nausea or vomiting. He has been normal after that with no discomfort. The day 2 (48 hours) stools have been normal in colour though softer then usual. As mentioned he is at approx 52 hours now. Researching the net has caused substantial anxiety in me though he is calm and confident nothing will happen to him. Attempts to convince him to undergo examinations have failed. I would be grateful if you could advise on his current risk assessment. Will he be fine in the coming hours/days; is there a high probability of his developing complications or worse? Please help

Paracetamol Overdose Outcome

Sorry to hear of your friends overdose. The seriousness of the overdose is determined in hospital by checking the Paracetamol levels and comparing the level to a defined treatment line on a graph that provides risk of toxicity. If the level at 4 hours was below the treatment line (assuming accuracy of timing of O/D), then no treatment is indicated, but if above then a drug called NACC or N-Acetylcysteine is administered intravenously.

Paracetamol overdose essentially causes liver failure and this is a horrible illness which results ultimately in death. It doesn’t happen instantly, but occurs over days and is marked by progressive jaundice, nausea, vomiting, confusion, clotting abnormality with bleeding and septicaemia in some cases. At this stage, the only way to resolve this is liver transplantation if severe. Fortunately, the advent of NACC has significantly reduced this and outcome is usually good if administered early.

As for your friend, they were clearly not treated with NACC, but deemed to be below the treatment line and not requiring anything further than presumably a psychiatric assessment as to why they took the overdose in the first place. However, you mention that he passed black stools that were stinky and have now returned to normal. Assuming he wasn’t given activated charcoal (which would make his stools black), the likely cause is due to upper gastrointestinal bleeding. In an overdose like this, the most likely cause is a Mallory-Weiss tear (caused by retching and a resultant tear in the gullet or oesophagus). This often settles without need for any specific treatment and it sounds like this has happened with your friend.

What Is Your Friends Risk From Paracetamol Overdose Now?

Happily, your friends risk from the overdose is now low. Assuming he has not become jaundiced (yellow colour to skin and eyes), he is unlikely to have further problems from the overdose itself. If his stools become black again, he should go back to have this assessed further. Clearly he has been medically assessed and treated. He was sent home as his risk was deemed low from the overdose itself. Presumably, he was assessed from his risk of overdosing again, but this is possibly the more significant factor in your friend’s long-term outcome.




My name is Dr Peter Thatcher MBBS, MRCPI and I am a consultant physician and gastroenterologist in the UK. I have an interest in internet based medicine and administer this site in my spare time. I hope you find this site useful and informative. If you have any suggestions, please Contact Me or if you would like to comment on my site, please do so by Clicking Here. If you like the site and would like to make a donation to support what I am doing please do so by Clicking Here. Thank you for visiting and please drop by again!