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Paracetamoloverdose Presenting to an Accident & Emergency Department of a Regional Hospital in Hong Kong

We carried out a review of the patient resuscitation records and hospital notes of paracetamol overdose patients initially treated in the Accident and Emergency Department of Tuen Mun Hospital during the period starting from January 1998 to April 1999. Altogether there were 42 patients but 46 cases were recruited in the study because 4 patients had overdose twice. Ten (22%) were male, 36 (78%) were female and young female constituted the majority of the patients Forty-three cases (93%) took an overdose of paracetamol as a means of committing suicide and 20 cases (43%) ingested 10 grams or more of paracetamol. The most common provoking causes were adjustment disorder (18 cases, 39.1%) and acute stress reaction (8 cases 17.4%). The majority of the cases presented early and within 8 hours after the overdose. Two cases had impaired liver function, 3 had prolonged prothrombin time and 5 had transient metabolic acidaemia in the absence of liver failure. All patients recovered uneventfully. Forty one cases (89%) were given N-acetylcysteine (NAC) infusion, of these 6 had toxic paracetamol level, 24 had non-toxic level because NAC was given before the availability of paracetamol level in many cases and it was undetermined for the other 11 cases. Hypersensitivity reaction to NAC infusion was common (8 cases, 21%) but there was no long term sequelae. Highly variable approach in the use of NAC was noted, we suggest to set a clinical check-list for the management of paracetamol overdose especially concerning the time to check the serum level and the initiation of NAC.