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Analgesic Poisoning – Causes, Symptoms and Treatment
Analgesic poisoning occurs when too high a dose of painkillers such as paracetamol or ibuprofen is taken. It can be life-threatening and requires immediate medical attention.
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Analgesic poisoning occurs when too high a dose of painkillers such as paracetamol or ibuprofen is taken. It can be life-threatening and requires immediate medical attention.
What is Analgesic Poisoning?
Analgesic poisoning refers to a toxic reaction caused by taking an excessive dose of analgesics (painkillers). Analgesics are medications used to relieve pain. The most common causes include over-the-counter drugs such as paracetamol (acetaminophen), ibuprofen, and aspirin (acetylsalicylic acid), as well as prescription opioids such as morphine or codeine. An overdose may be accidental or intentional and always constitutes a medical emergency.
Causes
The most common causes of analgesic poisoning include:
- Accidental overdose: Taking too large an amount, for example by forgetting a previous dose or through uncontrolled self-medication.
- Intentional overdose: Occurring in the context of suicide attempts, particularly with paracetamol.
- Combination products: Unknowingly taking multiple medications containing the same active ingredient.
- Alcohol: Concurrent alcohol consumption significantly increases the toxic effects of many analgesics, especially paracetamol and ibuprofen.
- Liver or kidney disease: Impaired organ function slows the breakdown of active substances and increases the risk of poisoning.
Symptoms
Paracetamol Poisoning
A paracetamol overdose often progresses in phases and may initially appear mild before serious liver damage develops:
- Nausea, vomiting, abdominal pain (within the first few hours)
- Apparent recovery period (between 24 and 72 hours)
- Liver damage with jaundice, severe abdominal pain, and liver failure (from day 3 to 5)
NSAID Poisoning (Ibuprofen, Aspirin)
Non-steroidal anti-inflammatory drugs (NSAIDs) can cause the following symptoms in overdose:
- Nausea, vomiting, stomach pain
- Gastrointestinal bleeding
- Dizziness, tinnitus (especially with aspirin)
- In severe cases: kidney damage, seizures, loss of consciousness
Opioid Poisoning
Poisoning by opioids can be recognised by the following signs:
- Severely slowed or shallow breathing (respiratory depression)
- Extreme drowsiness or loss of consciousness
- Very small pupils (miosis)
- Blue discolouration of the lips or fingernails (cyanosis)
Diagnosis
Diagnosis of analgesic poisoning is made in the emergency department using:
- Blood tests: Measuring drug levels in the blood (e.g. paracetamol concentration), liver and kidney function, full blood count.
- Urine tests: Detection of active substances or metabolites.
- ECG: Assessment of cardiac function, particularly in NSAID poisoning.
- Medical history: Information from the patient or accompanying persons about the substance taken, the amount, and the time of ingestion.
Treatment
General Emergency Measures
If analgesic poisoning is suspected, the emergency services (911 / 999 / 112) or a poison control centre should be contacted immediately. Key steps include:
- Do not give food or drink, and do not induce vomiting unless specifically instructed by medical professionals.
- Place an unconscious person in the recovery position.
- Keep medication packaging or containers for the medical team.
Specific Treatments
- Paracetamol poisoning: Administration of activated charcoal (within 1 to 2 hours of ingestion) and the antidote N-acetylcysteine (NAC), which protects liver cells.
- NSAID poisoning: Gastric lavage, activated charcoal, and symptomatic treatment (gastric protection, fluid administration).
- Opioid poisoning: Administration of the antidote naloxone, which rapidly reverses opioid effects; monitoring of respiratory function, and mechanical ventilation if required.
Prognosis and Prevention
When treated promptly, the prognosis for analgesic poisoning is generally good. However, delayed treatment, especially in paracetamol overdose, can lead to permanent liver damage or death. Prevention includes:
- Always taking medications as directed on the package leaflet or by a healthcare professional.
- Storing medications safely, out of reach of children.
- Not combining painkillers without medical advice.
- Consulting a doctor for pain that requires long-term use of analgesics.
References
- World Health Organization (WHO): Guidelines for the Management of Drug Overdose. WHO Press, Geneva.
- Brunton L.L., Hilal-Dandan R., Knollmann B.C.: Goodman & Gilman's The Pharmacological Basis of Therapeutics. 13th Edition, McGraw-Hill Education, 2017.
- Dart R.C. et al.: Acetaminophen poisoning: an evidence-based consensus guideline for out-of-hospital management. Clinical Toxicology, 44(1):1-18, 2006. PubMed PMID: 16496488.
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