Hospital Admissions For Paracetamol Overdose-Rising Rates In Young Females
C Mc Closkey, R MacNicholas
National Liver Transplant Unit, St. Vincent’s University Hospital, Elm Park, Dublin 4
Paracetamol overdose (POD) is the commonest form of self-poisoning in developed countries. POD can result in acute liver failure, treatment with N-acetylcysteine significantly reduces mortality.
To quantify the number of admissions to Irish hospitals with POD 2009-2019. We sought temporal trends in age, gender, length of stay, calendar month, associated diagnosis and mortality.
The Hospital In-Patient Enquiry (HIPE) dataset was used to identify all discharges with the ICD code of POD (T39.1) from 2009–2019.
10,891 admissions occurred over the study period. The incidence rose from 21 to 24 per 100,000. 68% were female and 82% were intentional. Most patients (58%) were under the age of 34. Peaks were seen in late Spring and Autumn. Overall mortality was 0.8%, with increasing age associated with worse outcomes. 1.4% developed acute liver failure and 2.9% developed acute renal failure. Admissions rose by 22% overall, 4% in males, and 32% in females. Females aged 10-19 accounted for a significant proportion of this increase, rising 77%, now accounting for 24% of total admissions. Within this group the prevalence of anxiety-related diagnoses (F41) rose 13-fold, and those with a history of self-harm (Z915) doubled. Rates of depression (F32) were stable. The prevalence of alcohol misuse (T51) and smoking (Z720) fell.
Approximately 1000 admissions for POD occur annually. A prior study on POD (1993-1999) showed an incidence of 30-40 per 100,000. Our data shows legislation introduced in 2001 limiting access to large quantities has led to a sustained reduction in admission rates. The rise amongst young women defies this trend. Further research is needed to ascertain reasons for this. There is no prohibition, on age grounds, regarding the sale of paracetamol-containing products. Age related restrictions should be considered.