The death of Naomi Musenga, as a result of paracetamol poisoning, last December, is a reminder that overdose of this common painkiller in our medicine cabinets is frequent and dangerous. It is a medicine and it should be used properly.
The medical conclusions of the death of Naomi Musenga, the 22-year-old girl who died last December in Strasbourg, following a major malfunction of the SAMU, recalls that the overdose of paracetamol is dangerous for health.
According to the Strasbourg public prosecutor, Naomi died “from paracetamol poisoning absorbed by self-medication over several days”. She specifies in a press release that “the progressive destruction of his liver cells has been extended to all of his organs leading quickly to his death”.
More specifically, Naomi died of “fulminant hepatitis of toxic origin”, ie the destruction of all the cells in her liver, an organ essential for the proper functioning of all the other organs in the body. From where a verdict of death or of necessity of transplant of another liver when it does not work any more …. But we still do not know for what disease and what pain Naomi took too much paracetamol.
Paracetamol, a friend that can harm you
Despite an apparent banality, self-medication with paracetamol carries risks, especially because large doses, obvious or hidden, are harmful to the liver. In England, this over-the-counter pain reliever is also widely used in suicide attempts by massive overdose by seeking death from fulminant hepatitis. This is followed by generalized edema, including of the brain, brain dysfunction (encephalopathy) and generalized bleeding.
But without going as far as suicide, accidental overdoses of paracetamol, that is to say repeated intakes of more than 4 grams per day in adults (60 mg per kg and per day in children, are also devastation everywhere. In France, as in most developed countries, they are the 1e cause of severe acute hepatitis requiring liver transplant!
The obvious paracetamol and the “hidden” paracetamol
Paracetamol is the first-line “level 1” painkiller and therefore the most widely used. We do not know exactly its mode of analgesic action: it has long been classified as a peripheral analgesic, but it is now believed that its mode of action is central, not morphine.
Sold pure and without a prescription in pharmacies under various brands Doliprane, Dafalgan or even Efferalgan, paracetamol calms pain and fever. But paracetamol is sometimes more “hidden”, being associated with other molecules in various preparations against the common cold, such as Fervex, or in other pain medications, such as Ixprim …
A recent study conducted by the National Medicines Safety Agency (ANSM) shows that paracetamol is the most prescribed and consumed analgesic in France. Sanofi and UPSA share the market. Nearly 14 boxes are sold per second or 422 million boxes per year in France. Since January 1, 2018, more than 230,980,000 boxes have been sold.
A better understood toxic mechanism
It was known until now that this toxicity of paracetamol for liver cells was linked to the presence in the cells of this organ of toxic amounts of calcium. Those responsible for this influx of calcium into the liver cells are called TRPM2, these are small channels located in the membrane of the liver cells.
In the presence of “acetaminophen”, the active substance in paracetamol, these channels open and allow more and more calcium to enter the liver cells until death follows. Acting on the TRPM2 channels could make it possible to widen this window of action.
The importance of respecting daily doses
A study published last November in the British Journal of Clinical Pharmacology and carried out on 663 patients hospitalized for severe liver damage caused by taking paracetamol, showed that many people exceeded the recommended daily dosage.
However, respecting the maximum daily dose and the maximum dose per intake is essential. The maximum tolerated is 3 to 4 g per day for an adult (maximum 4 x 1 g or 8 x 500 mg per 24 hours) and 10 to 15 mg per kilo of body weight in children in 4 doses per day, separated by at least 4 hours. In addition, treatment with paracetamol should be as short as possible and should be strictly adapted to the duration of the symptoms. If the pain or fever lasts more than 3 days, it is best to see a doctor.
It is also not recommended to take too much paracetamol if you consume a lot of alcohol (more than four drinks per day for a man, more than 3 for a woman) and it should be discussed with a doctor beforehand. if you are being treated for epilepsy, tuberculosis, AIDS, because of the risk of interactions with drugs.
What to do in case of paracetamol overdose?
As the site specifies poison control center, “The first symptoms of paracetamol overdose are nausea, vomiting, loss of appetite and abdominal pain. However, these symptoms are vague and nonspecific. If overdose is suspected, it is important not to not wait for symptoms to appear “.
Currently, the harmful effects of an overdose of paracetamol can only be treated with an antagonist (N-acetylcysteine) if it is administered in time, that is to say within 18 hours, before the liver cells are damaged.
“The sooner an overdose can be detected, the greater the chances of recovery.” In summary, see a doctor quickly or call the poison control center.
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