• C Beer, N Pakravan, M Hudson, L T Smith, K Simpson, D N Bateman, and S H L Thomas.
• Wolfson Unit of Clinical Pharmacology, School of Clinical and Laboratory Sciences, University of Newcastle, Newcastle upon Tyne NE2 4HH.
• QJM. 2007 Feb 1;100(2):93-6.

BackgroundIt 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.AimTo determine the frequency of severe liver dysfunction following paracetamol overdose when paracetamol concentrations are below current UK antidote thresholds.DesignRetrospective case note review.MethodsDetails were collected from all patients admitted to liver transplant units in Newcastle and Edinburgh with paracetamol-induced hepatotoxicity.ResultsOf 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.DiscussionIn view of the rarity of this event, this research does not suggest a need to lower the current thresholds for antidotal treatment.

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