Consequences

I'm driving on this particular shift, my crewmate is in the back dealing with the patient.

I'm grinding my teeth at the waste.

The patient is almost certainly going to die – he's taken an overdose. The tablets he's taken, and the way he's taken them, mean that parts of his body will start to fail over the next few days. His immediate future is hospital bed, then an ITU bed, then either waiting for a transplant or death. It's too late for any treatment to work on him.

He's not in any pain, he doesn't feel weak, he has no symptoms.

He talks to my crewmate. The body language suggests that he is upset but not suicidally depressed.

It was one of those 'cry for help' things – asking why he did it gets the answer that he wanted to die, but now they don't. It's a common enough reason – that they change their mind and then phone us.

Everyone can get these pills – you can read the inference, how can they be that dangerous if you can buy them over the counter?

He lives in a nice house, has a family, had his future ahead of him.

I suspect that he thinks that they'll have a 'stomach pump', a chat with the psychiatrists and then come home. He doesn't realise the damage that he has done to his body.

We don't talk about the outcome to the patient – we'll leave that to the hospital after his blood tests show if he is telling the truth or not. We'll only see him for the ten minutes it takes us to drive him to hospital.

I'm hoping that the patient is lying, that he hasn't done what he says he has, but the empty pill packets speak for themselves.

I know I'll be thinking about him for the next few months long after I've forgotten his name.

His mother is travelling with him.

He's fourteen years old.

90 thoughts on “Consequences”

  1. ::sigh:: We get those here in the states too, and always as tragic. Maybe, just maybe, he'll make it and the liver damage won't be too horrible. I hate seeing kids do this, means that there's a deeper underlying problem in society/family/friends that is not being solved. Adolescence is hard enough without drugs (as I'm not too far out of that age myself).For those who don't know, Paracetamol is the same thing as Acetaminophen aka Tylenol. Taken with alcohol it destroys your liver. http://en.wikipedia.org/wiki/Paracetamol This is not a pleasant way to die, and a 14yr old certainly does not deserve to go like this.I really do hope he makes it.

  2. It's such as tragic waste, why do children feel that this is a good way to get attention? For what ever reason this kid needed help, but as we all very well know support services which have any connection with mental health are under resourced.Lets hope he pulls through.

  3. My sister in-law took an overdose on Friday – she took at least 20 co-codamol and goodness knows what else. She's my age – 24. I don't believe she actually wanted to kill herself and luckily she didn't – I think it was a 'cry for help' more than anything. She was rushed to hospital and given the antidote, then kept in overnight and seen by the crisis team at the hospital before she left. Now she seems to be back to 'normal' – but the worry with this kind of thing is, how long before she does it again? I'm a radiographer and I've seen so many patients who have self-harmed and overdosed – it's such a waste and I really don't think most people are aware of the consequences (it's certainly not a quick or painless way to die!)I really hope the boy in your post recovers well, it's so sad that such young people feel the need to do this kind of thing.

  4. I disagree. Many things in the home are potentially lethal if used contrary to the instructions on the packet – knives, power drills, drain-cleaner to name but a few – but they are also very useful. The key is not to remove them from the house altogether, but to teach children from an early age to treat these things with the necessary respect, be aware of the damage they can do, and basically, not be an arse.Perhaps a little bit of it is that we are faced with so many blindingly obvious warnings – “Caution, water from the hot tap may be hot” and so on – that it's hard to tell what is a genuine serious and important warning, and what is merely the manufacturer's legal team trying to cover every tiny angle.

  5. I had a friend who used a paracetamol overdose as a cry for help, thinking, like this patient, that he could just be 'pumped out' and all would be well….he died 3 days later, in multiple organ failure and in pain :((It really should be publicised more-if you don't reallt mean to dies, don't use paracetamol!

  6. I have been a lurking reader of your blog since I saw an article on it in The Guardian a couple months ago. I appreciate the time you take to share your life and experience with the world–what a gift youre giving others! This post really got to me–I hope you have someone in your life who can hold hope for you as you are constantly doing so for others. Take care! and thanks again for your insight and caring.

  7. Forgot to mention, on the issue of being able to buy paracetamol products easily: as a student I worked for a large pharmacy and whenever we sold any painkillers (paracetamol or otherwise) we would tell the customer what dosage the tablets could be taken in, warn them of interactions with other drugs or other contraindications and warn them not to take any other paracetamol products with what they were buying (if they were buying paracetamol). Our tills would bring up a warning when the product was scanned as well. We'd get a few regular customers and as soon as you saw them you'd know exactly what they wanted – usually Nurofen Plus (ibuprofen with codeine) or Solpadeine (paracetamol with codeine). Occasionally they'd be after Paramol (paracetamol with dihydrocodeine). We'd sometimes get calls from other pharmacies in the area warning us of a particular person who would be trying to get hold of Paramol, and we'd have to take it off the shelves before that person came in. With the regulars I would try extra hard to emphasize the point: “These tablets are for occasional use only” etc. It is difficult to refuse sale though when they only want a small amount – how do you prove they're abusing the drug? I'm sure a lot of people do go round all the pharmacies in the area buying the same thing, but unfortunately most of them will slip through the net.

  8. I'm a non-medical reader simply fascinated by your blog. This post hit me smack in the heart. I simply don't know how you do this job. But thank you for doing it, and thank you for writing about it with such tenderness, compassion and well-directed fury.

  9. Me too, although it's easy to see a tragedy like this and want to have some simple rule or action that will make sure it doesn't happen again, it's just not going to work.I understand why you posted that Steve, but I don't think this child's mum is in any way to blame, and given the likely outcome, she'll be in hell for the rest of her life because of it.

  10. It is a horrid, horrid drug. It does the most horrible things to you and yet it is available in Tesco on the shelf. Sure they won't let you buy too many in a single transaction, but there are plenty of Tesco's etc….I have been to plenty of these jobs Tom, not so many as young as this chap thankfully, but a lot of them not much older. They play on your mind for months after, wondering if they were telling the truth. I have been to “sensible” people too, people of medical standing who have taken them! Why oh why….

    It makes me angry and sad at the same time whenever I go to these overdoses. I want to pick up the 16 yr old girl/boy etc etc and shake him/her, I wonder what makes these young people want to do it, I just don't understand and I really don't think I ever will.

    I hope they have managed to do something for him at A&E I really do, as if not I hope its not too painful for him and his family over the coming years/months/weeks/days or however long it takes……..

    So sad

  11. Jeepers Tom, it's those kinds of calls that make me wonder how you continue to do that job….Thank God is all I can say.

    I wish kids could speak out without using drugs to do so 🙁

  12. Wow.Didn't know paracetomol was so )potentially) deadly. Presumably if you follow dosing guidelines, there's no problem? I think of the times where someone in the family has flu and as the clock ticks over to 4 hours, takes the next dose. How long would you have to take it fdor it to affect a healthy-ish adult. And more to the point, should I switch to Calprofen from Calpol for a 3 year old?

  13. What should you do if you discover someone who has just overdosed? (other than, obviously, calling an ambulance) I seem to think you shouldn't make people who have OD'd vomit, but if liver damage and death are the alternatives.. what's the best thing to do?

  14. Paracetamol – its lethal, even in small doses over the max dose – which for an adult is 4mg per day.Usually taken by suicidal people, along with alcohol, thinking this will end it all – they wake up the next day feeling “better” emotionally, but its too late, they have now sentenced themselves to a very slow painfull death.

    this is the reason in the UK you can only buy it in packs of 16, doesn't stop the pharmacy hopper, but does make it harder.

    He should have gotten the works when he arrived in A&E

    Hopefully he'll be suitable for a transplant, if they can find a match

    may whatever belief system he believes in, be with him

  15. That was a heart breaking enough story without the last line.It's such a shame.

    On my very first placement as a student nurse I was asked to sit with a girl of 16 who had just taken 150 paracetamol tablets, she told me she thought no-one would react if she only took one packets worth so went to her friends/nans/cousins and collected their tablets.

    Two days later I was there when we had to transfer her to ITU, such a shame.

    I never did find out if she made it or not, and I doubt I will ever forget her name.

  16. For confidential, non-judgemental emotional support 24 hours a day:Samaritans:Phone: 08457 90 90 90*email: jo@samaritans.orgPost: Chris, PO Box 9090, Stirling FK8 2SAOr in person at your nearest branch, check samaritans.org(*its a local rate call in the UK, you can knock off the first zero and add +44 to call from abroad, or check http://www.befrienders.org to find a local service)

  17. Just a question Tom/UK crew: how easy is it to get Acetaminophen in the UK, and in what doses? In the States a bottle with 100 500mg pills is easy to come by. Also are the Codeine/Tylenol varieties strictly regulated? (US/CA may know this as Type 1, 2, etc Tylenol)

  18. While the point is well-taken, can I nitpick on the detail? 🙂 4mg paracetamol can't be the lethal daily dose. Typically a single paracetamol tablet can contain up to 500mg and one tends to take them two at a time… It's a unit error, right? 4 grams makes more sense, especially given the dire imprecations not to take more than 8 tablets in any 24 hour period.I'm actually in the process of trying to shake off a Solpadeine habit that… kind of snuck up on me. But it's funny: while I was taking the with-paracetamol variant, I wasn't really thinking about the paracetamol at all, because paracetamol on its own had always been completely ineffective with my headaches. Suicide wasn't even close to being my intention, I just wanted something for the headaches. (Yes, I know, it becomes self-perpetuating, with analgesia-induced headaches, and then the nasty rebound headaches when you stop.) So even at my worst I never took more than the maximum dose for a 24 hour period – in fact almost never took that much; usually just(!) 2-4 tablets on most days.

    But my concerns about not escalating were still based around a worry about the codeine. I didn't have any idea what a truly dangerous dose of paracetamol was and assumed there would be a certain amount of headroom in the guidelines on the boxes and leaflets. Not that I broke those guidelines except for the “if symptoms persist” part. And now i worry and wonder less at how physically crap i've been feeling. Maybe it's not too bad; I am feeling better now I've stopped and, I think, got past the rebound headaches.

    Because I wasn't suicidal and knew I wasn't going to OD, I tended to just think of paracetamol as benign, almost irrelevant because it never touched my headaches on its own, only really coming into effect if I had a temperature as well. I'm starting to think that was a mistake.

    Oddly, when I took this to a doctor, she almost laughed, and said “oh we worry when people are taking more than thirty or forty a day.” I said “whaaat?” but still – based on worries about the codeine. Now I'm thinking, how did they survive that amount of paracetamol over a long period of time? I think worries about Solpadeine's addictivity have been around longer than there was a with-ibuprofen variant.

  19. It's easy. You pick them up from the shelves and take them through the till. A pharmacist at the till may remind you not to take too many or ask what other medication you're on, but in a supermarket you can just take them straight to the main tills and have them go through with your normal shopping. I imagine even a normal till-worker might balk if you tried to buy several packets at once, but I wouldn't want to bet on it; not the way the one I had today was mostly talking about her ageing labrador's arthritis…The with-codeine variants like Solpadeine are 'behind the counter', at proper pharmacies, so you do actually have to go up and ask for it from someone with a bit of training. But that's it, and if the staff at one pharmacy are starting to recognise you and query your purchases you can always go to another. (It was when a supermarket pharmacist refused to sell me more than a half-pack, and that after a lecture, and I found myself starting to think about going out of my way to other pharmacies to avoid such recognition, that I decided to take it as my wake-up call.)

  20. The recommended dose is “no more than 4g in 24 hrs.” The toxic dose is around 15g. Pretty scary. There are plenty of prescription drugs that are more benign than that. Gives you some idea of the power of the pharmaceutical industry. And advertising.(I found that here. The article is actually about toxicity in alcoholics, and it wasn't what I expected.)

  21. Paracetamol (Acetaminophen) is on the General Sales List (GSL) provided it is in packs containing no more than 32 x 500 mg tablets. GSL items can be sold anywhere. There is a restriction for GSL paracetamol that not more than one pack is sold at a time but how many corner shop owners know that? The supermarkets are usually better, with the point of sale scanning terminals enforcing the rule (I've seen this happen).Paracetamol starts being mildly hepatotoxic (in an adult) if you take more than 4 grammes (eight tablets) in a 24 hour period. Ten grammes in a single dose is typically treated as the threshold for needing active treatment with an antidote. Thirty-two tablets (16 grammes) will cause death in about 4% of untreated cases. Twenty-five grammes is highly likely to kill you – slowly and painfully. Obviously these figure go out of the window if another hepatotoxin (i.e. alcohol) is taken at the same time. Some LD50s for those of you who are interested: Oral, mouse: LD50 = 338 mg/kg; Oral, rat: LD50 = 1944 mg/kg.

    The introduction of the maximum 32 tablet pack was a legislative response to the number of deaths from paracetamol poisoning. As you can see from the above, it's still enough to kill some people. An alternative, that was not pursued, would have been to require all paracetamol sold to have been compounded with methionine (Co-methiamol). The methionine doesn't reduce the useful effects of paracetamol. Paracetamol damages the liver by depleting its supply of glutathione which methionine replaces. (Strictly speaking it's a paracetamol metabolite that does the damage by soaking up glutathione.)

    Who knows how many deaths insisting on only co-methiamol being sold would have prevented at little cost?

    8/500 co-codamol tablets (8mg codeine and 500 mg paracetamol) are [P] products and can be sold to the general public from a pharmacy in packs of 32 or less. All other compound codeine preparations (more codeine or larger quantity) are [POM] and require a doctor's prescription.

  22. Another issue is accidental poisoning, where the person takes preparations containing paracetamol that they are unaware of ie lemsips etc etc, in addition to taking paracetamol tablets.I thought the reason that Co-methiamol was not made the standard preparation was cost. Maybe they need to review this, as the cost is very high – both in human terms but also monetary

  23. A very sad post and the last line the absolute clincher. I have just come from the BBC news website reading about the man who died following a cake eating contest, we have that 9 year old girl missing and now we read this post and all you can say in all honesty is why? what is life and this world all about?This “can only buy 2 packs of 16 paracetamol” always amuses me because I live near a big city so could quite happily visit every single place that sold them and have more than enough to do myself in probably ten times over. I hasten to add I have absolutely no intention of such a thing but I feel sad that the opportunity for someone who is that desparate and can only see that as thier only option would be able to go about it very easily.

    I note my receipt from boots that helpfully tells me when I have bought a cold remedy with paracetamol in and not to take anything else at the same time but don't know what can be done to solve the issue as I don't think putting paracetamol on prescription only a viable option.

  24. What a terrible waste of a young life. My dad's a nurse and he warned us from a very young age about the dangers of paracetemol in its various forms and how much damage you can do with a small amount of the stuff. Maybe an answer could be to sell paracetemol in smaller packs, maybe packs of 4 or 6 tablets. I know it won't stop people from overdosing if they are really determined but it might stop the accidental fatalities that are currently happening.

  25. My local corner shop very properly refused to sell me both lemsip and a packet of paracetemol, as they both had paracetemol in them. I was annoyed at the time because I was only stocking up, but they were right. So (at least one) corner shop is enforcing it.

  26. Tom that is so sad, sad story. I hope he makes it not a nice way to die when he didn't mean it to happen and just wanted help. Paracetomol is deadly but effective as a painkiller I use it for headaches, but am careful not to exceed the limit and check other meds for ingredients before taking them if I have taken paracetomol.I would hate to get restricted to buying 4-6 tablets at a time instead of 16, I keep some at work, some in the car/bike, some at home and some in my bag so I have various packets open at different places… the message needs to be clearer, and possibly not have them sold cheaply by supermarkets through the till ensuring you speak to someone before buying them.

    Sage

  27. Long time lurker, first time poster. What a hideous story but thank you for posting it – I never even thought of the consequences of taking that amount of drugs. I too was in the “pump your stomach and all will be fine” school of thought.

  28. What's even worse is that it's possibe to buy paracetamol with methionine in it, specifically to aviod this situation, but not many shops stock it because it's too expensive and the profit margin is reduced too much. A real shame, esp when you look at the financial cost of an ITU bed, let alone the human cost.

  29. I don't think a parent of teenagers should have paracetamol in the house, full stop. It's just too dangerous, especially when aspirin and ibuprofen can do the job much more safely. Formulating paracetamol with methionine would be a help, but fundamentally this was an avoidable tragedy – one of far too many the same.

  30. Ironically, it is very much harder to kill yourself with plenty of prescription drugs than it is with paracetamol. You could take several month's supply of prozac and be fine, but take a week's worth of paracetamol and you could well end up needing a new liver.There is an 'antidote' of sorts, but reading between the lines of Tom's post, it sounds as if the kid took a staggered overdose and/or presented late- which means treatment is less likely to be successful(barely works at all after 12 hours). And that's if you don't have an allergic-type reaction to the treatment , which is also quite common.There are almost no immediate effects from a paracetamol overdose. After about 18 to 24 hours, you may get some nausea/vomiting, and not a lot else. After that, you start to feel a bit better, for a short time. Then you start to notice some abdominal pain. In the next few days, you turn yellow. You become confused, and may hallucinate. Your blood pressure is low, and you leak fluid under your skin until you look like the Michelin man. Your failing liver can no longer make the proteins that allow your blood to clot so you start to bleed. You bleed from the holes that are made as people collect blood samples, you bleed under your skin, you can bleed from anywhere and every where. Your kidneys will fail, meaning you need dialysis. At this stage, if you do not get a liver within a short period of time, you will die. Medicine has yet to invent a machine that can replace the work of the liver. Hopefully you will be unconcious as your near the end, because it is highly unpleasant.I have no idea why people take this drug to end their life.

  31. A silly teenager who has taken an overdose of paracetamol to get everybody wound up may refuse the antidote in order to cause a stir. Our new Mental Capacity Act does not allow you to treat them against their will – strictly speaking it never was allowed. So the unfortunate victim must then be left to die a slow death weeks later. They come to their senses after a day or two but by then it is too late for the antidote. Bad that.

  32. I think part of the problem may be how cheap it is. If you're not fussy about getting the Big Brand Name, you can get a pack of 32 500mg paracetamol tablets for 50p. That's great when you're at the office and have a headache and need to get something for it quickly that doesn't cost more than your pocket-change. But, swings and roundabouts, its cost-effectiveness and accessibility, the things which make it a very useful drug, are the very things that also make it dangerous in cases like this.

  33. In this age of barcodes, most supermarkets have a block on buying more than two packets, or products in the same transaction. I guess this at least bring's it to the attention of “Johnny or Jenny No Stars” manning the check-out.I was once caught out buying two packets of co-codamol and some “cold and Flu” tablets that also contained paracetamol. I guess as I didn't look like a suicide risk, and wasn't attempting to buy forty packets, the check-out girl just let me put them through as a separate transaction? As a rule, perhaps they shouldn't?

  34. how awful and i was feeling fed up for myself, don't now. I often look at your blog when i feeling down or fed up it normally does the trick – people are worse off or how funny! keep up the good work. I work in a children's hospital so who knows they might end up here.regards linda

  35. But asprin and ibuprofen are less safe painkillers in general. They have more possible bad side effects when taken. Paracetamol is very safe if taken correctly. I have long term pain and take paracetamol over ibuprofen and asprin.

  36. The issue (IMHO) is that its an EASILY available drug, that young patients (adolescents) who want attention will take whatever is available (addn this is) and drink a tad bit of alohol to keep themselves happy. What needs to happen is more education, more outreach, and more help for those in need. Something must have been wrong for him to take it; just goes to show that the socail net is still weak.Eug

    PS- You also want to avoid asprin in children+teens, but that's a diff. issue.

  37. You have to take quite a large dose over the 4g/day limit for it to be lethal (unless it's mixed with a load of alco-ma-hol), and even then you would need to be young and in a pretty poor nutritional state. Unfortunately, since most parasuicides are young girls (who, on the whole, are often unnecessarily concerned about their weight and thus dieting and thus a tad malnourished), then accidents can happen and a cry for help/attention ends up with another senseless death.

  38. You can only buy packets of 16 at a time. This was a shange introduced by the government in around 1998 or so. The other option was to make all paracetamol contain methionine or N-acetyl cysteine, but that would mean that they didn't taste (or is it smell?) very nice and would've pushed the price up, so they went for the small packet size.I don't know why there isn't a license for huge bottles of paracetamol containing methionine if people want to have it, but there you go.

    In many shops they won't let you buy enough paracetamol to be a risk. As one of the other commenters mentioned, it gets flagged up in barcodes so that all the paracetmol you're buying (even inadvertently) gets added up.

    Boots, which is the UK's #1 chain of pharmacists, is very strict about this. Last year when I had a broken arm and didn't want to have to keep nipping to the chemists to keep myself dosed up I wasn't allowed to buy too many packets together. I tried to argue that I was hardly a suicide risk, but they wouldn't even let me split it up into two purchases. It was a bit annoying, but very professional of them.

  39. I suppose that's true -those young people in Bridgend were all successful in their suicide attempts using items to hang themselves. I guess the difference though is that someone who hangs themself in the woods probably does intend the outcome, whereas many overdoses are maybe just intended as a 'cry for help'.All tragic stories whatever the intended outcomes, though.

  40. Strictly speaking, it doesn't damage the liver by soaking up the supply of glutathione, it's what happens when the glutathione is soaked up and you've still got NAPQI that kills you.For those who care: normal paracetmaol metabolism is largely by glucoronidation or sulphonation, but these pathways can only take so much and the CYP450s take up the slack if they're overloaded (and stil do a bit even if they're not). This pathway transforms the paracetamol into NAPQI, which is usually metabolised by glutathione (or N-acetyl cysteine) conjugation

    When the glutathione is used up, there's nothing to take out the NAPQI and it reacts with proteins and nucleic acids. Then you get liver failure and a slow and painful death as your liver melts (well, it doesn't literally melt, but it's a pretty good way of describing it)

  41. Simple answer is that the police would step in and section them, allowing treatment to go on without the patients consent. Suicide is still illegal in the UK.A very tragic case, and one brought about by the publics lack of knowledge about the drugs available to them.

  42. no no no no no.Not aspirin. The kid was 14 and aspirin can cause lyell's disease in the under 16s, so the MHRA don't allow it for kids.

  43. sorry guestblogger, but I'm afraid that suicide isn't illegal in the UK. It hasn't been since the suicide act of 1961.It is, however, illegal to counsel or solicit anyone to kill themselves.

  44. “…suicide isn't illegal in the UK” and nor should it ever be.Our life, our right to end it – anything past that makes us property, not people.

  45. A few years ago, a young woman who was staying at my home decided to OD on acetaminophen, alcohol, Depakote, Tegretol, and oxycodone. A little while later, my son came and told me (after she told him).Anyhow, I activated EMS out to my home, grabbed my gear just in case she started to have airway issues, and explained to her (she was getting pretty drowsy at this point) what was going to happen, and basically explained she could either cooperate with them (in terms of taking the activated charcoal), or they would make her take it in the E.R., via NG tube. She chose to cooperate with the medics when they got there. The guys who arrived I happened to know personally; not sure if that was a positive or negative at the moment.

    In her case, she got lucky. Her liver functions were out of whack for a while, but she got most of her function back. Stayed in the hospital a few days, got a psych eval (who released her as not a threat to herself! See below…).

    She was 19 at the time. Three weeks later, she slit her wrists. Again, in my home. EMS activated again. By the time they got there, her bleeding was under control, with me holding pressure on the wounds.

    I have since heard that she tried to off herself twice since. But she stopped living with us shortly after her second try.

    Sheez. Welcome to the world of bipolar disorder.

    NEVER, EVER, EVER try to commit suicide in the house of an EMT or paramedic!

  46. Had a similair thing a while ago with a well known tricyclic antidepressant. The patient had taken an od after a row with his girlfriend. They made up after he had taken the tablets and then called 999. He looked quit pleased with himself when we picked him up. When he told us how much he had taken and of what he must have seen the looks in our eyes and became quite worried. Had to explain to him the seriousness of the tablets he had taken on the way to a and e. Why do they prescribe such high numbers of these tablets on each prescription??????????

  47. I also lost a friend at 16 who over dosed on paracetamol……she had used it as a cry for help and after realising life was not that bad had declared to us as we gathered around her hospital bed she did not want to die, a week later we all gathered again but that time it was at her funeral, such a waste. Twenty years on i still miss her.

  48. Having just got home from MCA training.. If someone were refusing life saving treatment such as this, then their capacity to make the decision could be strongly questioned.Also, you immediately are classes as not having capacity until you are 18, though there are certain cases for phyical illness where a special status can be applied from the age of 14 (which is how doctors are allowed to prescrie contraceptives to a 14 year old without their parents consent).

  49. Paracetamol is a horrible drug, and one thing I always say when teaching about harm reduction in suicide and self harm is “never, ever take praracetamol”.. ever.This is such a sad case. So very sad

  50. The official overdose margin (in those with no risk factors) is 12g or 150mg per kg of body weight (whichever is smaller) – This is the level at which liver damage is assumed likely.Taking paracetamol with alcohol doesn't increase the risk of liver damage (unless you're already an alcoholic). Alcohol and paracetamol actually compete for the same metabolic pathways so taking it with booze may actually give some protection in an overdose. It's in the literature if you care to search it out.

    Damage only occurs when the liver's supply of glutathione runs out and it can't produce more fast enough. It takes around 3 to 4 days for the liver to become completely depleted of glutathione. Once that happens liver injury starts to occur. So, in most cases the antidote (n-acetylcysteine) can be given and any potentional damage eliminated completely.

    Staggered doses are more complicated but the treatment remains pretty much the same.

  51. Maybe the answer is a few case staudies on the leaflet. I guess the drug companies are worried about profits, but a horror story spelling out just how your body fails might make people who want a cry for help type option move on to something less painful.The general reaction to those people whose organs failed after testing a drug shows that we all have a horror of that kind of thing, and spelt out in black and white it would at least inform not only potential overdosers but also the addicted, that this is not a harmless drug.

  52. That is very very sad!I work with adolescents following brain injury and it doesn't get any easier to witness such sudden and unexpected tragety. I think I have the balance right though- of maintaining a professional approach and objectivity alongside the feeling of desperate grief, sadness and compassion. The emotional connection keeps me grounded and motivated to provide the absolute best service that I can. The day I stop feeeling is the day I will resign!

  53. A very sad piece Tom. Your writing is so wonderful and evocotive. Again, it made me cry.I remember talking to someone from Samaritans about teenage suicide and he suggested that they don't want to die for ever, just for now, to get through the bad patch. The most tragic thought everytime I hear of a youngster dying.

  54. Good God…14 years old. Such a damn shame. I know being 14 is no easy ride (speaking from experience here as I am not yet 15) but goodness knows what drove him to that.

    My sympathies with everyone involved.

  55. Sorry to hear about that, Emily. Several years ago, when my son was 17, he overdosed on Tylenol. (I was not even aware that he'd been depressed.) After a bit, he changed his mind, and told me what he'd done. Ambulance to hospital. Four days in ICU. When I brought him home, I was terrified he'd do it again. I watched him like a hawk. I threw away any Tylenol that was in the house. He had to go back to his doc to get follow-up liver function tests, which were wacky for a while, but he made a full recovery. He is no longer depressed. He is very in touch with his feelings, and he talks about stuff. He's funny and smart and talented, and I thank God he came out of his room that night and said, “Call an ambulance! I did something stupid!” He'll be 23 in May. 🙂

  56. I had awful tooth ache one weekend and ended up taking about 800mg ibuprofen over 5hrs l rang the emergency dentist and the receptionist told me off for taking so many ibuprofen and said that they were not prepared to see me because of that and l had better start taking co-codomol and/or paracetomol (yes she did say mix and match) as it was safer and if l still had a problem ring them back Sunday.Instead of following their wonderful medical advice! l have to be careful anyhow with medication Paracetamol knocks me out and l can feel fairly rough, Aspirin makes me tired, other medications can also affect me but Ibuprofen l can take so l stocked up on the alternatives of oil of cloves, Bonjela and a few other rub on type tooth remedies.

    I was hit by a new pain bout around midday Sunday and rang the emergency dentist who said you are to late we are closed go to your dentist tomorrow in the mean time take whatever you need in paracetamol and/or co-codomol

    Come the Monday l staggered into my dentist and apologised for having had a 200mg ibuprofen while waiting for him.

    He went off his trolley about the emergency dentist refusal to see me and their advice and was going to take action over them and told me that 200mg of ib was not enough for my problems and not to apologise he was sorry l had so much trouble from his “profession”…

    By now l not only had a hole the size of Blackwall tunnel in a tooth l also had sever chemical burns in my mouth from all the “rub on remedies” l took.

    The pain from the tooth had been so bad l did not realise the damage l had done until the tooth was out and that pain had stopped the other started until it all healed 🙁

    The dental nurse also interrupted and said her boyfriends sister had been told the same advice a few weeks before.

  57. Because if you're in the sort of wrecked physical or mental state where you need prescription medication and have difficulty going out or getting about, then it is difficult for you to leave the house, put in a repeat prescription request at the doctor's, remember to go back a couple of days later to get the new scrip, then hike over to a pharmacy to fill it.Getting a months' worth of tablets all at once is often the only practical way for many people with all sorts of illnesses.

  58. I immediately recognized Paracetamol, but your last line was a real sucker punch. Jesus.I'm a pharmacist and in university we often discussed Paracetamol being number 1 suicide drug in the UK, because it's easy to get and the lethal dose is relatively low. I don't know how popular it is with suicides in Portugal, but it is without a doubt the most sold medication.

    Still, it's one of the best pain-killers around, as I certainly wouldn't give Aspirin to a child/teenager because of Reye's syndrome, and I don't even recomend it to an adult (stomach problems? coagulation disorders?).

  59. It seems that there's a widespread belief that a stomach pump will always sort everything out, and there'll be tearful, chastened family and/or friends at the bedside… maybe, finally ready to listen to someone who doesn't feel heard?I can't think of a name or date offhand but I'm pretty sure I've seen soaps, movies and dramas where the unrealistic stomach pump/reconciliation story was used, it feels SO familiar to me from fiction.

    I've never felt that way, but a close friend's situation made me understand why someone people feel that a suicide attempt as a “cry for help” seems like a good choice at the time.

    I also think that, given the high success rate for procedures like resus on TV dramas, there is also a belief being promoted that once you're in A&E, everything can get fixed and life goes on as normal.

    Perhaps major soaps like EastEnders, Hollyoaks and whatever should have a story feat. a “cry for help” that ends in an ugly and unwanted death from paracetamol overdose?

    I can't think of any other way to get the message across to the majority of people (I realise this is about as likely as an epsiode where everyone gets along, treats each other with respect, and the main characters get through the day with no dramas….).

  60. Just call the ambulance – *Do Not* make them vomit as this can cause a lot more problems that it may possibly solve.(It's also why stomach pumps are a lot less common than they were in the past).

    There are specific treatments for specific overdoses, but nothing that should be started in the home without medical supervision.

  61. That ibuprofen misinformation isn't just in the UK. The concern is over bleeding, which is not the problem it is made out to be. Yes, for some, bleeding can be bad, but most have other issues resulting in clotting problems, such as warfarin use (And they generally shouldn't take ibuprofen anyway) or liver damage.For blood and platelet donation, they tell you not to take ibuprofen because the platelets don't clump, and they need them to in order to skim them off your blood in the separator.

    Just some info… 🙂

    Sorry about your run-around, BTW. Not fun when you are in pain.

  62. The post is so sad and this comment is so true, both for teenagers and those of us a lot older but not necessarily much wiser.

  63. Supermarkets do indeed put a block on bulk-buying. I tried to buy some adult paracetamol and some infant calpol (1 carton of each) in the same transaction (my toddler and I both had a virus with a temperature) and I wasn't permitted to do so. They called a supervisor who could see that this wasn't really an excess purchase but I had to pay for them in two transactions. The lady on the till told me that she is instructed not to allow this unless the supervisor says so. So they are trying to make it harder to purchase paracetamol in excess.I feel there should be an advertising campaign informing the public about the dangers of paracetamol OD. So many people imagine that they will gracefully faint, be the centre of attention and be saved in A&E.

  64. Dang. I had no idea this drug was so potentially dangerous. I knew I wasn't supposed to take it with alcohol because it could be bad for you, but kill you? Yikes. I have a bottle of that I got from Walmart with hundreds of pills in it. You can literally buy it by the bucket here. Crazy.

  65. I OD on Tylenol about six years ago. I don't remember how many I took and I told my husband about 15 minutes after I did it and we ran to the hospital and they fed me charcoal and all that fun stuff. Not until after they had me on suicide watch did they tell me what could have happened to me. I don't have any thing wrong with me. I was lucky and so far I haven't had anything show up on blood tests and I try not to take any medicines anymore but there are times unfortunately when you have to. I only take 2 Advil and if it doesn't help then I try to deal with the pain. I feel bad for the kid but there is help out there. I know because I'm getting it now.

  66. A few years ago I had to deal with a Coroner case (well… we don't call it this way on this side of the Channel, but it gives the idea) of an accidental Paracetamol poisoning (and death) of a toddler.The mother was a foreigner and did not understand the pediatrician instructions…

    …she has been in the country for eight years, but her family men didn't allow her to learn the language of the country she was living in to prevent her to be “corrupted”.

    The death was recorded as accidental, but I felt sad for the mother….

    Andrea (MD, once EMT)

  67. Is everyone here aware of just how easy this is to get in the US? You can buy a bottle of 500 x 500mg in the gas station or in the grocery store. There are effectively no restrictions whatsoever. Every household in America has a bottle of at least 100 sitting within easy reach of everyone. None of this is exaggeration.

  68. I suspect that he thinks that they'll have a 'stomach pump', a chat with the psychiatrists and then come home. He doesn't realise the damage that he has done to his body.More people need to read this post.

  69. Actually, in the UK children can have competence long before 18yo. Our literature (North East Ambulance Service) suggests using the Gillick competency test. This identifies children aged under 16 who have the legal capacity to consent to medical examination and treatment, providing they can demonstrate sufficient maturity and intelligence to understand and appraise the nature and implications of the proposed treatment, including the risks and alternative courses of actions.In reality, we can have children who are 12yo and are classed as mentally competent, however, it is up to the idividual clinician to decide if that person has competence at that moment in time. If not, we are to act in the best interests of the patient and a mental health section isn't necessarily needed.

  70. Took a call only a few days ago from a guy who (as does happen sometimes) didn't want an ambulance, just wanted some medical advice (which I am not actually allowed to give). He had taken an almost cerainly lethal dose of co-codamol, but point-blank refused to give me his address (and was calling from a mobile which happened to narrow his location down only as far as East London). I offered to pass him over to a paramedic (either Clinical Telephone Advice or even one of the HEMS guys; not really procedure but I'm sure nobody would have minded), but by this stage the guy just wanted to hang up, which is is excactly what he did. Took me a few goes ringing back before he answered, but fortunately he did and I was able to describe a sufficiently detailed vision of his potential immediate future to convince him to let me get help to him. We are not medically trained, and if somebody else had taken the call who had no knowledge of the drug's effect, they may well have simply followed protocol and left it there as “cancelled as called” (although I hasten to add that I can't think of anyone in control who wouldn't have called this guy back).

    Just hope he was ok in the end.

  71. Um…Not very long ago (8 months or so?) I was one of those people. It also certainly wasn't the first time, and not the first attempted method.

    I spent 4 days in hospital after being ushered in there in a daze by a concerned stranger (mixed states aren't nice) and just got even more depressed that I didn't manage to hide from people for a few days and let the stuff work, and just felt like crap for using a bed when I didn't want to live.

    I was diagnosed as bipolar not long afterwards… after the CMHT had sent me home about 4 times in about 2 weeks. Since then life has been… different. But that's another story.

    I'd say as regards the availability of paracetamol comments that if you want to do it, you'll find a way. If paracetamol is prescription only people will find other silly ways to harm themselves. It is a huge shame that people don't realise the long term damage paracetamol can do, which allows for acts like this. I knew and didn't care, which says a lot for my mental state at the time. I don't think many people know though :/

  72. Of course, if you go to a supermarket with self-service tills you can just put through as many as you like without anyone challenging you or noticing.I was behind a woman recently who bought six packets of 12 paracetamol in three separate transactions, all cash. She'd put two through the scanner, pay the cash, two more, pay the cash, two more and pay the cash.

    She was in her 40s or 50s, noticed me watching and said “Don't worry, my doctor normally gets the chemist to give me a large box, but sometimes I run out on a Sunday”.

  73. Well..I did it as well once when I was just 19 and had gone through hell after a rape and the death of a very close friend (I'm 22 now). I also had problems at uni where I didnt feel accepted and didnt find the strength to produce anything, really.. I felt left alone and very, very bad. I thought I was pathetic, filthy and not worth anything.

    One night and after a week of horror I decided to simply get drunk. You wanna forget, run away and just make it stop – the emotional pain, the feeling of failure and dirt. You don't think straight and you surely don't consider the consequences when all you want is go to sleep and never wake up again.

    Unfortunately drugs like Aspirin and Paracetamol don't do that for you, they don't even make you go to sleep.

    I took 90 (!) pills of paracetamol (500mg) and 30 Aspirin.

    I did pass out but only because I was dead drunk and my flatmate (who's a doctor in the states now – funnily enough) phoned an ambulance (which I don't remember at all).

    The next thing I remember is being on two drips and connected to a lot of machines.

    I had thought I can't feel worse but surely this was the ultimate feeling of just wanting to die. Not so much because of what had been happening but because of my physical state…

    I did get the right treatment and an antidote (because there is one, something with “A”??) and obviously I lived.

    I never did anything like that again (because it frightened the hell out of me being so close to dying in the most painful way and full of agony) but was still to go through a lot.

    There were still moments coming up where I just wanted to be dead but I was too afraid of the process of dying.

    I got a really good doctor (psychiatrist) and a lot of support and I'm over it now. I enjoy life now and I managed to leave all my horrible experiences behind. I've got a good job, a boyfriend I love and I'm 7 months pregnant.

    It's easy to judge and it's hard to understand but sometimes the mind plays horrible tricks on you. You cant think straight and see sense but after a while you almost certainly regret what you've done and then it might be too late…

    I am glad I made it and although I can understand why people do it I know that usually there ARE alternatives and ways out.

    It's a horrible, horrible way to die and to chose it hurts you much more than you intended when all you wanted is TO MAKE IT STOP.

  74. This post has been haunting me for more than a week, ever since I read it. That poor boy, and his mother… I hope he makes it. Thanks for writing so eloquently about this.

  75. Hollyoaks DID do a story line involving someone dying from a paracetemol overdose. Lewis Richardson (Mandy's brother) overdosed on paracetemol after realising how similar he was to his abusive father. The next morning he was still alive so just forgot about it. When a friend found out what Lewis had done he convinced him to get checked out. The scene when Lewis found out that the overdose was fatal was horrible and has stuck in my mind ever since.

  76. a silly teenager? how stupid are you. this 'silly teenager' obviously has some form of mental illness and is NOT something to be talked of like that. Its just the same as a person suffering from depression or bulemia or bipolar. They are all mental problems which can't be controlled or switched on or off and technically bulemia and anorexia are forms of suicide, are people silly for having that aswell? are they crying out for help and attention in your eyes? the fact that he didnt speak to anyone about it and ended up doing that shows he doesnt cope or think as perhaps you would. Thats a problem not an attention seeker. Thats someone whos clearly unstable and not in their right mind- just the same as any adult who would go on to do this. So shut up, you haven't been through it so dont assume you know hes this and that. If you had gone through this, you wouldnt be calling it silly- idiot.

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