The February edition of ‘Eyes on Evidence’, the free monthly e-bulletin from NHS Evidence covering major new evidence with an explanation about what it means for current practice, includes an expert commentary on new evidence from a large single centre cohort study which examined the clinical impact of staggered overdoses and delayed presentation following paracetamol overdose.

The study analysed data from 663 patients who were admitted for paracetamol-induced liver injury, of whom 161 (24.3%) had taken a staggered overdose, usually to relieve a variety of common pains, such as abdominal or muscular pains, headache and toothache.

The researchers suggest that prognostic criteria may have reduced sensitivity in staggered overdose patients. This is because despite lower total ingested paracetamol doses and lower admission serum alanine aminotransferase levels, staggered overdose patients were more likely to be encephalopathic on admission, require renal replacement therapy or mechanical ventilation, and had higher mortality compared to single time point overdoses.

They conclude that staggered paracetamol overdoses should be treated as high risk for the development of multiorgan failure, and should be considered for N-acetyl cysteine treatment irrespective of admission serum paracetamol levels.

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