Paracetamol is a main metabolite of phenacetin, and since its introduction it has become increasingly popular as a mild analgesic which is available without prescription. When taken in the recommended therapeutic dose of l g 6-hourly, paracetamol is relatively free from unwanted effects, and in particular, unlike phenacetin, there is little to associate it with renal damage. However, when taken as a single overdose, paracetamol can cause hepatic necrosis, the severity of which seems to be proportional to the dose of drug absorbed. All patients ingesting over 10 g (20 × 500 mg tablets) are at risk from liver damage, which may be potentiated by previous consumption of substances that induce microsomal enzymes, such as barbiturates or alcohol. Since the first reported cases of fulminant hepatitis due to paracetamol overdose in 1966 the number of cases of such self-poisoning has risen annually, with a concomitant increase in the number of deaths.
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