Acute pancreatitis following paracetamol overdose

Area of Science:

• Toxicology
• Gastroenterology
• Pharmacovigilance

Background:

• Paracetamol (acetaminophen) is a common over-the-counter analgesic.
• Acute pancreatitis is a severe inflammatory condition of the pancreas.
• Adverse drug reactions to paracetamol are typically associated with liver toxicity.

Purpose of the Study:

• To highlight the potential link between excessive paracetamol ingestion and acute pancreatitis.
• To raise awareness of a less recognized adverse drug reaction to paracetamol.
• To emphasize the importance of considering pancreatitis in cases of paracetamol overdose.

Main Methods:

• Case report of a 17-year-old female presenting with symptoms after paracetamol overdose.
• Diagnostic workup including laboratory tests (amylase) and CT scan.
• Assessment of causality using the Naranjo adverse drug reaction probability scale.
• Literature review of reported cases of paracetamol-induced pancreatitis.

Main Results:

• The patient developed acute pancreatitis following ingestion of 15,000 mg of paracetamol.
• The Naranjo scale indicated a probable link between paracetamol and pancreatitis.
• A literature search identified 36 previous cases of pancreatitis associated with excessive paracetamol use.
• This adverse reaction is not widely recognized or documented in standard drug references like the British National Formulary (BNF).

Conclusions:

• Acute pancreatitis is a potential, albeit uncommon, complication of paracetamol overdose.
• Clinicians should consider pancreatitis in the differential diagnosis of abdominal pain following paracetamol overdose.
• Increased awareness can facilitate earlier diagnosis and management of this serious adverse drug reaction.