ACETAMINOPHEN POISONING

Acetaminophen* is being increasingly used as a mild analgesic/antipyretic both as a replacement for phenacetin and as a substitute for aspirin. In Britain the current consumption of acetaminophen has been estimated to be about 50% of that of aspirin, which in turn has been calculated to be the equivalent of 6,000 million tablets per year.1 The consumption of acetaminophen has risen progressively over the past decade owing to the virtual absence of adverse effects from it when taken in ordinary doses, but this has been matched by a steady increase in the number of deaths per year from acetaminophen overdose during this time. However, the total number of deaths from acetaminophen relative to its usage when compared with aspirin is still very small. In 1971 in England and Wales there were 29 deaths due to overdosage of acetaminophen alone compared with 233 due to aspirin or salicylate alone.2 In Britain, acetaminophen tablets are as freely and widely available as aspirin tablets, and brand names are actively promoted. In view of this widespread usage it is perhaps surprising and gratifying that the number of admissions to hospital in England and Wales for accidental acetaminophen overdosage in children under 5 years of age during 1970 was considerably less than 8003 compared with about 6,000 for aspirin.4 One can speculate on the reasons for this difference and these could include the fact that acetaminophen tablets are usually larger than aspirin tablets and, more especially, there are very few specially flavored pediatric tablets of acetaminophen.