2 days ago my friend took 20 paracetamol as a suicide attempt. Will she die? She was sick but didnt throw up now she has pains in her upper abdomen. Please help!

Firstly, if you haven't done so, *get this person to hospital immediately*. Regardless of what other people have said to the contrary, 20 tablets is a potentially lethal dose.

Although publicly available, paracetamol has a very narrow therapeutic index. This means the difference between a useful dose and a harmful dose is small.

Even worse, the paracetamol causes extreme damage to the liver, and sometimes the kidneys. The liver can tolerate a huge amount of damage over time, but because it has so many functions, if it is damaged quickly, as in an overdose, it cannot cope and will necrose. Acute liver failure is a medical emergency.

And the worst thing is that the damage is maximal 3-4 days after taking the paracetamol - the first couple of days may be asymptomatic, aside from some nausea, possibly vomitting.

Treatment needs to be started immediately, and becomes less successful the longer it is delayed. Acute liver failure due to paracetamol overdose is a common problem in the UK especially, and on the rise. It is not a pretty way to die, so you need to get help immediately.

I'm speaking from experience, as I have seen patients after paracetamol overdoses (I'm a medical student), trust me, I am not over-exagerating anything.

The following text is from the British National Formulary for treating paracetamol overdose. The BNF is the guide to prescribing and treating people using drugs, and one of the first sections deals with overdose, especially of paracetamol due to its dangers.

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Paracetamol
As little as 10–15 g (20–30 tablets) or 150 mg/kg of paracetamol taken within 24 hours may cause severe hepatocellular necrosis and, much less frequently, renal tubular necrosis. Nausea and vomiting, the only early features of poisoning, usually settle within 24 hours. Persistence beyond this time, often associated with the onset of right subcostal pain and tenderness, usually indicates development of hepatic necrosis. Liver damage is maximal 3–4 days after ingestion and may lead to encephalopathy, haemorrhage, hypoglycaemia, cerebral oedema, and death.

Therefore, despite a lack of significant early symptoms, patients who have taken an overdose of paracetamol should be transferred to hospital urgently.

Administration of activated charcoal should be considered if paracetamol in excess of 150 mg/kg or 12 g, whichever is the smaller, is thought to have been ingested within the previous hour.

Acetylcysteine protects the liver if infused within 24 hours of ingesting paracetamol. It is most effective if given within 8 hours of ingestion, after which effectiveness declines sharply; if more than 24 hours have elapsed advice should be sought from the National Poisons Information Service or from a liver unit on the management of serious liver damage. In remote areas methionine (2.5 g) by mouth is an alternative if acetylcysteine cannot be given promptly. Once the patient reaches hospital the need to continue treatment with the antidote will be assessed from the plasma-paracetamol concentration (related to the time from ingestion).

Patients at risk of liver damage and therefore requiring treatment can be identified from a single measurement of the plasma-paracetamol concentration, related to the time from ingestion, provided this time interval is not less than 4 hours; earlier samples may be misleading. The concentration is plotted on a paracetamol treatment graph, with a reference line (‘normal treatment line') joining plots of 200 mg/litre (1.32 mmol/litre) at 4 hours and 6.25 mg/litre (0.04 mmol/litre) at 24 hours (see Paracetamol poisoning treatment graph). Those whose plasma-paracetamol concentration is above the normal treatment line are treated with acetylcysteine by intravenous infusion (or, if acetylcysteine is not available, with methionine by mouth, provided the overdose has been taken within 10–12 hours and the patient is not vomiting).

Patients taking enzyme-inducing drugs (e.g. carbamazepine, phenobarbital, phenytoin, primidone, rifampicin, alcohol, and St John’s wort) or who are malnourished (e.g. in anorexia, in alcoholism, or those who are HIV-positive) may develop toxicity at lower plasma-paracetamol concentration and should be treated if the concentration is above the high-risk treatment line (which joins plots that are at 50% of the plasma-paracetamol concentrations of the normal treatment line).

The prognostic accuracy of plasma-paracetamol concentration taken after 15 hours is uncertain, but a concentration above the relevant treatment line should be regarded as carrying a serious risk of liver damage.

The plasma-paracetamol concentration may be difficult to interpret when paracetamol has been ingested over several hours. If there is doubt about timing or the need for treatment then the patient should be treated with an antidote.

I don't know why you, or your friend at least, haven't already, go see a doctor ASAP. Paracetamol is not good for you. It's the worst suicide drug ever, you generally don't die from it, but it can cause liver damage. Just go see a doctor.

Also, should point out that it can lead to liver failure and death within a couple of days after the overdose. It's like committing suicide by having you 5-year old brother jamming your head with a rubber duck until you die.

2 days ago my friend took 92 paracetamols, it was his birthday and he simply wanted to die. he has lost everything. ifelt helpless, he told his flatmate who called ambulance. he didnt want to go so they called the police. was horrible knowing this at the time. he did go eventually, but he walked out of the hospital the next day. police was called again but he refused. its a shame that they couldnt section him but he promised he would go to the doctors. He is a very big lad, lets hope he doesnt die. I suffer with depression, but suicide for me is a cowardless thing to do. your hurting the people who love you. i love my friend very much and trust me i was there to help him through this. iv always been there for him. any of you people concidering ever to try something like this, imagine the people like myself getting ill from watching someone you love dearly wanting to die. my depression has got much much worse from this. my birthday today lets hope i see him today. my birthday wish is for my friend to be around with me forever. hes my best friend just like a brother.

She will not die. Not for just taking 20. And she threw up as well, which helps a lot.

Get her to the hospital just to be on the safe side.

Emergency room!

hi dazed and thankyou for ur comment am new to this site so bit slow on here yes wud be nice to chat as i have no out mates as my condition keeps me in

i myself has often tried suicide over and over again since i was 11 years of age i am now 45 and still to this day why only last summer did i find myself doing it again did i want to do it no did i want to hurt my loved ones nooo so u lot who hasnt sufferd from suicide thoughts and doing it i hope yous never do as tell you what yous wouldnt like the judgments that yous cast on others and by the way u get it 10fold back and if yous carnt uplift the person at the time just remember ONE THING IF THEY COULD STOP IT THEY WOULD selfish evil people who pass on judgments instead of love ooo an by the way i have only just been dignosed with adhd and possible bipolar test are still being done for bipolar ..... so u see y some of us dont know why we get these thoughts and then carry the act out i for myself is still struggling with those
suicide thoughts but least i know what triggers mine off now so hay help before yous judge...

no one dies with it

Probably wont die, but wont enjoy living for the next couple of decades if she doesn't get some medical attention.

"plea for attention"? Fuck you.
It's not a plea for attention if she told them -two- days later. Oh, I'm sorry? Were you enjoying feeling superior to the rest of us?

The only -really- helpful comments were from the med student and Putboy. The rest of you saw this as an opportunity to either try to steal the limelight with your own problems.

Big prop's here to elynab, there are forums and other sites you can put this. Don't expect anyone to be grateful for making seriously depressed people feel WORSE, by guilting them out of the only hope they feel they have. Maybe if you'd added something constructive at the bottom, I wouldn't have to put a scathing paragraph about you, but all I can see is;

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blah blah blah, don't do it because it upsets other people, blah blah, I consider myself depressed even though I just have a mild case of the sulkies, blah blah, I am better than other depressed people, because I am depressed (don't make me laugh) and I don't want to end it.

Signed, Better-Than-You

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But, thank you for everyone who said something to do with going to the hospital, something useful, instead of this bullshit about "I'm a pyschiatrist because I once did volunteer work for the samaritans, and you're all horrible horrible people and should aspire to be like me."

you need to get your friend to the hospital.

9/10 people will not die from 20 paracetamol tabs however its not that good for you either. She clearly needs psychiatric help as this was a plea for attention and that is not healthy at all. There are most definately some underlying problems that she has and until these are addressed she will conrinue to be unhappy in herself