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#1 |
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New Blood
Join Date: Sep 2005
Posts: 19
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Overdoses ?
Does anyone on this board have any medical knowledge of overdosing on painkillers ?
A friend of mine has an injured ankle and it has been sore for about a week, a few days ago he took 4 Paracetamol tablets (500mg) in one dose, the maximum dose is 2 tablets four hourly not taking more than 8 a day. He plans to take 5 before a rugby match tommorrow as he is desperate to play and said he would take a few more after the game. I said that it would damage his liver but he doesn't take the warnings seriously. Does anyone know the extent of damage these overdoses can cause ? |
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#2 |
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Anti-homeopathy illuminati member
Join Date: Sep 2003
Location: NT 150 511
Posts: 34,409
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IANAD, but this is not clever. The difference between dose and overdose for paracetamol is relatively narrow, and individual susceptibility varies. You might get away with accidentally taking four on one occasion, but to plan to take five after doing that, and then more, is really taking unnecessary risks. Also, while people recover from ODing on aspirin regularly, paracetamol is a different matter. It can totally destroy the liver and you're either getting a transplant or you're dead.
I'm not necessarily advocating this (except that my own doctor suggested to me that I should do it), but if he wants to go overboard, try a simultaneous dose (recommended rate) of paracetamol and ibuprofen. Rolfe |
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"The way we vote will depend, ultimately, on whether we are persuaded to hope or to fear." - Aonghas MacNeacail, June 2012. |
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#3 |
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Philosopher
Join Date: Jan 2006
Location: Vancouver BC Canada
Posts: 6,014
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Only a doctor can be officially specific, but the literature suggests that this dose could do permanent damage to the liver in some vulnerable people. There are recorded deaths at 6g/day. 5 tablets would be just under half a potentially lethal dose (OTOH, 5 tablets is about 10% the typical lethal dose).
I'd say he's taking a small chance of liver damage, and very little chance of death. |
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#4 |
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Muse
Join Date: Oct 2002
Location: Vancouver
Posts: 991
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IANAD either, but from my (admittedly limited) knowledge of this, liver damage arises when the concentration of paracetamol reaches a level high enough to saturate the primary (nontoxic) metabolic pathway in the liver. This causes some of the paracetamol to be diverted into the secondary pathway, which metabolizes it into a toxic byproduct. IIRC this dose tends to be around 4-5g/day for most people (though I don't doubt that for some people it might be less). I do know that alcohol, even in very small amounts, drastically lowers the "safe" dose of paracetamol, probably down to about 2g/day. So, in my nonexpert opinion he is likely not doing any harm.
However, I don't see the point in this. My understanding is that there is a limit to the severity of pain that can be blocked by paracetamol, regardless of dose. I second Rolfe's suggestion that he combine ~1g paracetamol with ~600mg ibuprofen. Paracetamol overdose is not the way to go. It involves a slow, painful death from the buildup of toxins in the bloodstream. And these aren't the kind of toxins that can be cleaned out by going on a juice fast for three days.
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"Great spirits have always encountered violent opposition from mediocre minds." --Albert Einstein "The common man marvels at the uncommon; the wise man marvels at the commonplace." --Confucious "The whole problem with the world is that fools and fanatics are always so certain of themselves, and wiser people so full of doubts." --Bertrand Russell |
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#5 |
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Illuminator
Join Date: Sep 2003
Posts: 3,602
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IANAD, but I do know some things about pain....agree with the others about the dangers of paracetamol, the ceiling effect, and the idea of combining with ibuprofen.
My bigger concern, however, is playing on the injured ankle....he may be setting himself up to do far more serious damage which may lead to severe, permanent damage and chronic pain. Doesn't seem worth it, to me at least. He'd be much better off tending to his current injury with safe medication use and rest. |
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Believe those who seek the truth; doubt those who find it. -Andre Gide I am naive enough to believe that society will be changed by examination of ideas through books and the press, and that information can prove to be greater than the dissemination of stupidity - Dr. Seuss |
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#6 |
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Philosopher
Join Date: Oct 2003
Posts: 7,953
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I don't know if it's even legal for a rugby player not to drink heavily. It's certainly strongly discouraged.
In any event, if he has ankle pain, he shouldn't be taking paracetomol at all. He should be taking an NSAID, such as naproxyn sodium, ibuprofen, or even aspirin. Preferably with codeine. Since you're in a country where they say "paracetomol" rather than "acetominophen," aspirin with codeine is probably available OTC. The concentrations of codeine are damn near homeopathic, but it does take the edge off. Oh, yeah, IANAMD. |
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"It probably came from a sticky dark planet far, far away." - Godzilla versus Hedora "There's no evidence that the 9-11 attacks (whoever did them) were deliberately attacking civilians. On the contrary the targets appear to have been chosen as military." -DavidByron |
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#7 |
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Mostly harmless
Join Date: Jul 2004
Location: Nor Flanden
Posts: 22,489
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__________________
"You got to use your brain." - McKinley Morganfield "The poor mystic homeopaths feel like petted house-cats thrown at high flood on the breaking ice." - Leon Trotsky |
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#8 |
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Graduate Poster
Join Date: Mar 2002
Location: London, UK
Posts: 1,403
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IANAD but Mrs D is a nurse - when in training she looked after a guy who had taken an OD of paracetamol and not sought immediate treatment. He realised he had done a stupid thing and he was looking forward to getting his life back on track. Four days later he was dead.
Nobody - do everything you can to discourage your friend from taking that much paracetamol - I think 5 before and more after the match are going to amount to an OD. IIRC 12 is all it takes to cause liver damage. Threaten to tell his coach, captain or whoever - you'll be doing him a favour. |
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"We must favour verifiable evidence over private feeling. Otherwise we leave ourselves vulnerable to those who would obscure the truth." Richard Dawkins - The Enemies of Reason |
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#9 |
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Graduate Poster
Join Date: Mar 2002
Location: London, UK
Posts: 1,403
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From Wikipedia
Quote:
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__________________
"We must favour verifiable evidence over private feeling. Otherwise we leave ourselves vulnerable to those who would obscure the truth." Richard Dawkins - The Enemies of Reason |
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#10 |
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Critical Thinker
Join Date: Nov 2004
Posts: 361
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It is really not sensible to be thinking of playing a rugby match with an ankle injury. Two weeks is out of the so called 'acute' phase of healing, but it needs gentle mobilisation, not a rugby match where there is the possibility of re-traumatisation. Those collagen fibres can be easily disrupted again.
Also, trauma causes an inflammatory process to occur in the body, so taking ibuprofen is much more beneficial than taking paracetamol on its own. Also, I would think that taking that much paracetamol is not good. Paracetamol is hepato-toxic and there is a very fine line between a normal dose and an overdose. My advice - don't play in the rugby game and continue to use R I C E - Rest, Ice, Compression and Elevation. Take Ibuprofen as indicated if it is still painful and then use gentle mobilisation. Go and see a physio or physical therapist or sports massage therapist who will use gentle mobilisation techniques and massage that will prevent scar tissue formation and so aid the healing process. This can also help to prevent the development of osteo arthritis around the joint in later life. |
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#11 |
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Kowalski
Join Date: Aug 2001
Location: gone
Posts: 9,286
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Paracetamol is not a friendly drug. Liver failure can occur easily and suddenly in cases of overdose, and as has been pointed out by several people already, overdosing is a fine line.
The problem is you don't really go from 'sick' to 'sicker' to 'I feel we should go to hospital'. You go from feeling ok to liver failure to dead, essentially. Cecil gave a rather good description of the metabolism and pathology behind it. I once tested an adolescent's blood for overdose of an unknown drug. Alcohol was evident on his breath, but he was being stubborn more than drunk. I calculated he must have taken at least 12, possibly 15 tablets in an suicide attempt. With the alcohol, he was lucky to survive. He claimed to be feeling ok and tried to check himself out. If he hadn't been convinced to stay, he would have gone home and died. His liver shut down overnight and he went into critical care for several days. Nope, not pretty. Athon |
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#12 |
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Critical Thinker
Join Date: Nov 2004
Posts: 361
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Whilst my wife was still nursing, before training as a midwife, she did a spell on liver HDU. She would tell me that they used to get some kids in who would take paracetamol as a cry for help, rather than really wanting to commit suicide. Some took as few as 8 to 10 at one time and would end up sick. They would be given the antidote drug, but at times this would be too late and unfortunately, some ended up in liver failure and with hepato-renal syndrome and also needed dialysis because of this. If they were lucky, some livers recovered, but others needed a transplant.
As has been pointed out already, it is a fine line and you can go from feeling well to collapsing and being seriously ill in a matter of hours. No intermediate at all. |
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#13 |
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Hipster alien
Join Date: Dec 2001
Location: not measurable
Posts: 16,940
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#14 |
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Neo-Post-Retro-Revivalist
Join Date: Aug 2005
Location: The Emerald City
Posts: 8,000
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I know someone who did just this. IIRC he took roughly 20 OTC-strength tablets, a bit more than Nobody's friend is planning on taking. He ended up in the hospital within hours, with acute liver failure. I don't recall whether he recovered any liver function, or needed a transplant; since, shortly after this, i quit hanging out with anyone who might have known.
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__________________
"All opinions are not equal. Some are a very great deal more robust, sophisticated and well supported in logic and argument than others." -- Douglas Adams "The absence of evidence might indeed not be evidence of absence, but it's a pretty good start." -- PhantomWolf "Let's see the buggers figure that one out." - John Lennon |
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#15 |
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Muse
Join Date: Nov 2005
Location: the wet side of the mountains
Posts: 826
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If you're referring to L.'s husband, he had a transplant. He's currently back in the hospital, having just had an appendectomy. The anti-rejection drugs suppress his immune function so badly that he'll be prone to horrible infections for the rest of his life.
All because of a toothache. |
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#16 |
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Neo-Post-Retro-Revivalist
Join Date: Aug 2005
Location: The Emerald City
Posts: 8,000
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__________________
"All opinions are not equal. Some are a very great deal more robust, sophisticated and well supported in logic and argument than others." -- Douglas Adams "The absence of evidence might indeed not be evidence of absence, but it's a pretty good start." -- PhantomWolf "Let's see the buggers figure that one out." - John Lennon |
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#17 |
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Muse
Join Date: Nov 2005
Location: the wet side of the mountains
Posts: 826
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Oh. I have no idea of the outcome of that one. He claims he's dying, but all in all, I'll believe it when I see the un-photoshopped medical documentation.
For that matter I'd want proof of the liver failure and not just a good stomach pumping. It's a sad thing when so many people have cried wolf that you have to be suspicious of everyone's medical problems until proven by documentation (though in this case the suspicion is sadly deserved). Heidi |
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