Paracetamol overdose: systematic review of case reports and national toxicological data (2018-2023)

Paracetamol is widely used as an analgesic and antipyretic, but its accessibility also makes it a frequent drug in overdose cases. Increasing rates of intentional paracetamol poisoning, particularly among adolescents, raise public health concerns. This study aimed to examine recent patterns of paracetamol overdose and identify risk groups for intentional self-poisoning.

A systematic review of published case reports (2018-2023) describing paracetamol overdose was conducted using PubMed, Scopus, Web of Science, and the Cochrane Library. Additionally, a retrospective analysis of telephone inquiries to the Czech Toxicological Information Centre (TIC) during the same period was performed.

Sixty-eight published case reports met inclusion criteria, with reported doses ranging from 6.5 to 250 g. Intentional overdose occurred in 50 cases (74%), including 11 teenage girls (22% of intentional cases). No deaths were reported in this subgroup. TIC recorded 3,318 inquiries related to paracetamol exposure between 2018 and 2023, of which 2,032 (61%) involved intentional overdose. Females predominated among intentional cases, particularly in children and adolescents, and the number of intentional overdoses among girls aged 0-19 years increased after 2020. The data indicate a growing number of suicide attempts involving paracetamol, particularly among teenage girls.

The majority of paracetamol intoxications reported in the literature and in national toxicological data were intentional, with adolescent females representing a key risk group. Increased attention to the safe use and communication of paracetamol-related risks is needed.