Missed Paracetamol (Acetaminophen) Overdose Due to Confusion Regarding Drug Names

Abstract

Immediate management of drug overdose relies upon the patient account of what was ingested and how much. Paracetamol (acetaminophen) is involved in around 40% of intentional overdose episodes, and remains the leading cause of acute liver failure in many countries including the United Kingdom. In recent years, consumers have had increasing access to medications supplied by international retailers via the internet, which may have different proprietary or generic names than in the country of purchase. We describe a patient that presented to hospital after intentional overdose involving 'acetaminophen' purchased via the internet. The patient had difficulty recalling the drug name, which was inadvertently attributed to 'Advil', a proprietary non-steroidal anti-inflammatory drug. The error was later recognised when the drug packaging became available, but the diagnosis of paracetamol overdose and initiation of acetylcysteine antidote were delayed. This case illustrates the benefit of routinely measuring paracetamol concentrations in all patients with suspected poisoning, although this is not universally accepted in practice. Moreover, it highlights the importance of the internet as a source of medications for intentional overdose, and emphasises the need for harmonisation of international drug names to improve patient safety.

How well are national guidelines relating to the general sales of aspirin and paracetamol, adhered to by retail stores: a mystery shopper study

“…This is an area which has been explored and highlighted as a potential medium to easy access of OTC medications. 21

Key recommendations Establish new laws: Illegal to sell >32 paracetamol at non-pharmacy counters. Non-pharmacy counters not permitted to sell paracetamol and paracetamolcontaining medications in conjunction with one another.

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The 100 most influential publications in paracetamol poisoning treatment: a bibliometric analysis of human studies

“…Most prominently, the extent of paracetamol exposure may be estimated from a measured serum concentration at a known interval after ingestion. However, there are difficulties in relying on patient reporting, and errors may occur concerning the reported drug name, dose and timing of ingestion (Zyoud et al 2012; Hewett et al 2013; Rutter et al 2013). A history of acute or chronic alcohol ingestion and biochemical tests of malnutrition have been explored as means of detecting an increased susceptibility to paracetamol liver toxicity; however, none of these are sufficiently reliable for routine clinical application (Waring et al 2008a, b, d; Zyoud et al 2011).…”