The case of the patient who took daily paracetamol for 12 years

The case of the patient who took daily paracetamol for 12 years

Antony Scholefield – 14 March 2017

A patient who died from undiagnosed chronic paracetamol toxicity had been taking up to 2000mg daily for 12 years, a coroner has found.

Maxwell John Free was prescribed 500mg of paracetamol four times daily, if required, for back and abdominal pain back in 2002, when he was in his early fifties.

His GP, Dr Mark Ostberg from Hobart, started regular kidney and liver function tests in 2014, and moved Mr Free onto a longer-acting formulation in June that year.

Mr Free’s medical history at that point included hypertension, COPD, IBS, benign prostatic hypertrophy hypertrophy and dementia.

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In September 2014, Mr Free moved into a nursing home. A day later, he suffered a full body seizure, which the local hospital diagnosed as secondary to low levels of electrolytes.

The hospital discharged Mr Free, but two weeks later his condition deteriorated in the nursing home, and he died from multiple organ failure at the age of 64.

A forensic pathology found a paracetamol level of 43mg/L.

Coroner Rod Chandler made no criticism of Mr Free’s doctors for failing to diagnose chronic paracetamol toxicity.

“In Mr Free’s case I am not satisfied that the signs and symptoms of his condition were sufficiently obvious to have enabled the diagnosis to have been made at an earlier time when remedial treatment may have been an option,” he said.

“Diagnosis of chronic paracetamol intoxication is often difficult and requires the combination of an astute history and recognition of typical clinical and laboratory abnormalities.

“Signs and symptoms are insidious in onset, often nonspecific, and easily confused with alternative diagnoses.”

But he added that long-term paracetamol use should be avoided if possible.

“When long term use is indicated then the known factors for chronic paracetamol toxicity must be considered.

“These include increasing age, nutritional status, chronic alcohol usage and medications.

“Mr Free’s unfortunate death is a clear demonstration of the risks associated with this treatment strategy and should serve as a reminder to all medical practitioners of the need to be alert to those factors.”

Ref: Australian Doctor. (2017). The case of the patient who took daily paracetamol for 12 years. [online] Available at: http://www.australiandoctor.com.au/news/latest-news/the-case-of-the-patient-who-took-paracetamol-daily [Accessed 14 Mar. 2017].