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Erratum: Accidental paracetamol poisoning

22 August 2012

The Editor of MSU has become aware of an error in this article published in the August 2012 issue of MSU (vol 3; no 4, 2012). The article incorrectly stated 'In a study of 662 patients with severe paracetamol-induced hepatotoxicity, 48% had not exceeded the recommended maximum daily dose of 4g'. The reference which accompanied this statement was also incorrect. The TGA has referred back to the original source cited in the Lubel et al article in the 2007 MJA.

The text should read 'In a study of 662 patients with acute liver failure, 275 were cases of severe paracetamol-induced hepatotoxicity. 131 (48%) of these 275 cases were the result of an unintentional overdose and 19 (7%) of the 275 patients had not exceeded the recommended maximum daily dose of 4g'. The correct reference is:

Larson AM, Polson J, Fontana RF, Davern TJ, Lalani E, Hynan LS, et al. Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study. Hepatology 2005;42:1364-72.

However this error does not change the underlying reason for the original article, which was to raise awareness among health professionals that in certain situations, paracetamol-induced hepatotoxicity can occur at normal therapeutic doses and, in fact, was the documented cause of death for a 45 year old Australian woman. Risk factors for paracetamol-induced hepatotoxicity include fasting, regular excessive alcohol use, and concomitant use of drugs that induce cytochrome P450 (CYP) 2E1 (e.g. ethanol).

In addition, there is a risk that consumers may take paracetamol-containing products such as those for the relief of cold and flu symptoms in addition to regular paracetamol for chronic conditions such as osteo-arthritis and therefore unintentionally overdose. Both consumers and providers should ensure that the total amount of paracetamol from any source does not exceed the maximum daily dose of 4 grams.

The author and the editor of MSU regret this error.