Comment by ctoa
11 hours ago
What those numbers really don't get into:
~80% of acetaminophen poisoning cases severe enough to end in hospital are intentional suicide attempts.
Those patients also have better outcomes though: family members know what happened, they get them to a hospital, they can take N-acetylcysteine as a timely antidote.
In the unintentional poisoning group, ~90% is from multi-day accumulation, they don't realize they've been poisoning themselves. They have a much higher rate of acute liver failure and death.
https://doi.org/10.1186/cc1475 https://doi.org/10.1016/j.cld.2013.07.001 https://doi.org/10.1097/mcg.0b013e31818a3854
Regarding the unintentional overdoses:
"There are two distinct clinical syndromes described in literature. One is the 'garden variety', wherein the patients ingested large amounts of acetaminophen with a suicidal intent .... The other pattern is seen in chronic alcoholics who ingest smaller amounts of acetaminophen in an attempt to relieve pain ...."
"The causes of chronic pain in the accidental overdose group were toothache, chronic backache, or headache."
https://link.springer.com/article/10.1186/cc1475
Yes, and those alcoholics also exactly fit the multi-day accumulation pattern. These aren't people taking one day of Tylenol after a bender for a hangover. The pattern is people with an impaired ability to process acetaminophen (alcoholics) taking multiple days of doses they can't handle (their daily safe dose is about 1/2 of normal) for chronic pain (like chronic back pain).