Warning over hidden paracetamol overdose danger-

Repeatedly taking slightly too much can be fatal

Repeatedly taking slightly too much paracetamol over time can lead to an overdose that is difficult to spot, but puts the person in danger of dying, researchers have warned.
Paracetamol is a widely used painkiller, and is easily available over the counter in pharmacies, supermarkets and other outlets.
If a person takes a large amount at one time it can be dangerous - if not fatal - and medical workers are trained to spot the symptoms of such overdoses, which are a common form of attempted suicide.
But now researchers have found that people who continuously take slightly too much of the drug on each occasion could be putting themselves at risk without showing any of the standard symptoms of a paracetamol overdose.
Researchers at the University of Edinburgh and the Scottish Liver Transplantation Unit looked at over 650 cases of patient admissions with paracetamol induced liver damage to the Royal Infirmary of Edinburgh over a 16 year period.
Of these, over 160 had taken a so-called "staggered" overdose, usually to relieve a range of common aches and pains, such as headaches, toothaches or muscular pains.
Study leader Dr Kenneth Simpson said that in such cases, "they haven't taken the sort of single-moment, one-off massive overdoses taken by people who try to commit suicide, but over time the damage builds up, and the effect can be fatal."
"On admission, these staggered overdose patients were more likely to have liver and brain problems, require kidney dialysis or help with breathing and were at a greater risk of dying than people who had taken single overdoses" he added.
For emergency workers the problem is that they have been trained to asses the patient's condition by taking a blood sample and finding out how much paracetamol is present. In the case of a single overdose this is helpful, but when people have been taking too much over a period of time they may have low levels of the drug in their bloodstream even though they are at a high level of risk of kidney failure and death.
"Staggered overdoses or patients presenting late after an overdose need to be closely monitored and considered for the paracetamol antidote, N-acetylcysteine, irrespective of the concentration of paracetamol in their blood," said Dr Simpson.
The study, published in the British Journal of Clinical Pharmacology, calls for more work to find new ways of assessing whether a patient can be sent home, needs medical treatment to counteract the paracetamol, or needs to be considered for a liver transplant.