Paracetamol hepatotoxicity and alcohol consumption in deliberate and accidental overdose

We studied the relationship between alcohol consumption and hepatotoxicity related to paracetamol ingestion both in cases of overdose with suicidal in tent and in cases where paracetamol was apparently taken for therapeutic re asons. In a retrospective study of 553 patients admitted to a specialist li ver unit between January 1987 and December 1993 with paracetamol-induced he patotoxicity, there was no difference in the severity of the hepatotoxicity following either a deliberate or an inadvertent overdose. Heavy alcohol co nsumption was more common in males than females and more commonly associate d with deliberate overdoses of >15g. There was no correlation between alcoh ol consumption and severity of hepatotoxicity (mean INR and the serum creat inine levels over the first 7 days after the overdose). The significantly l ower platelet count in heavy drinkers was probably the consequence of direc t alcohol toxicity to the marrow. Overall there was a greater incidence of heavy alcohol consumption amongst therapeutic misadventure compared to deli berate overdose cases, but there was no difference between the two groups w hen amounts of <10 g/day were involved. Eleven (29%) patients in the therap eutic misadventure group were depressed, 10 of whom had previously attempte d suicide. In conclusion, we were unable to demonstrate that heavy drinkers develop more severe hepatotoxicity following paracetamol overdose than non -drinkers, and from the material reported in this study, accidental overdos e is a better defining term than therapeutic misadventure.