In early 2007 I presented at the local A&E with notable jaundice. I was immediately defensive and increasingly angry because I just didn't understand why they kept asking me if I had taken an overdose, if I was feeling suicidal, if even by accident I may have taken too much of over the counter meds. Why were they wasting time? I'd already answered that! No – I didn't want to kill myself that day. No - I hadn't taken an overdose. I was almost in tears because no one seemed to believe me. Back then I didn't understand why they were all coming at me so strongly but I do now - - - -
Jaundice is a key symptom of Paracetamol overdose.
My notes also indicated discharge from a mental health ward only weeks earlier.
Looking back, I really can't blame them for hauling me over the coals…they needed to know.

My jaundice actually turned out to be a rare side-effect of one of my new psychiatric meds. I received treatment, switched meds and have never had a reoccurrence of the same problem.
The experience however, resurrected old thoughts of suicide and I began to explore the effectiveness of using Paracetamol in overdose. I discussed it with other like minded people and listened to many stories; I began to piece together information and it took very little time to realise that death by Paracetamol poisoning is not the simple and easy option it appears.
I have no medical training; the information given in this blog is derived from all the stuff I have encountered over the years. I am not about to tell you what you should or shouldn't do -I won't judge you – the choice is only yours to make – I just want to help make it an informed choice.

If you have ever considered suicide by Paracetamol overdose
YOU NEED TO READ ON……………

So, exactly what is Paracetamol?
"Come on” I hear you say.
"They're just painkillers – Just Headache tablets - you can buy them anywhere – dirt cheap too -- Duh!”

Ever read the little piece of paper before chucking it in the bin?
Paracetamol (Acetaminophen) (Tylenol) is an analgesic (painkiller) and fever relief (antipyretic) The exact nature of the therapeutic mechanism is not clear but it is easily the most widely used painkiller worldwide. I've heard that there may be some research suggesting possible benefits of Paracetamol with regard to preventing changes that lead to hardening of the arteries, a condition that contributes to things like heart attacks and strokes.
It is sold in tablets of 500mg but may also be prescribed. In UK shops other than pharmacies pack sizes are limited to a maximum of 16 tablets and most only allow 2 packs to be bought at a time. People use it routinely to treat headaches, fevers, toothaches, osteoarthritis and backaches amongst other things. The maximum amount of Paracetamol for adults is 1 gram (1000 mg) per dose and 4 grams (4000 mg) per day (If there is a history of alcohol abuse then the recommended dose may reduce to as little as half that due to assumed liver damage caused already by the alcoholism.) I seem to remember someone telling me that St John's Wort could also cause increased liver damage when taken in extreme combination with Paracetamol but I'm not sure. In general, children's dosages are based on a single dose of 10mg Paracetamol /kg bodyweight, which can be repeated 4-6 hourly, not exceeding four doses per 24 hours. It is contained in many over the counter combinations medicines such as cough bottles, allergy treatments and cold remedies so it is advised to take advice when buying such products to help guard against accidental overdose. When used according to the recommendations it is reliably effective with minimal or no side effects.

Possible side effects (Rare)
• Hypersensitivity reaction (rashes, itching and shortness of breath).
• Swollen face.
• Hypotension (low blood pressure) when given in hospital by infusion (a continuous drip of medicine into a vein in your arm)
• Unusual bleeding or bruising
• Significant changes in urine+/or flow
• Pancreatitis
• Hepatitis
• Blood disorders (eg. Low white blood cell count or low platelet count)
• Liver and kidney damage, when taken in overdose
Contra-indications
• Existing liver disease
• Alcoholism
• Medicines that thin the blood (e.g. warfarin).
• Medicines that address sickness and digestive disorders (Dolmperidone)
• Other anti-inflammatory (eg. Asprin)
• Other preparations containing Paracetamol , according to dosage.
• (New research in 2010 seems also to suggest Pregnancy)

So, how much is a fatal dose?
I know many of you have only read this far because you need the answer to this question, but I'm sorry – I can't give it to you. I spent years trying to figure it out myself and now that I'm pretty sure I know the what and how of it, I often wish I could ‘unknow' it. This, along with information on everything from hanging, trains and poisons to other overdoses, is burnt irrevocably into my mind and I often see it when I close my eyes. This is the dichotomy of suicidal planning – both comforting and frightening. I can't inflict this on anyone else and I certainly couldn't live with myself if I contributed to someone else's death. I'm sorry – but, when you read on you will begin to understand .

So, what actually happens if I deliberately overdose?
Worst case scenario is of course death. If your aim is parasuicide then the many variables involved in a Paracetamol overdose make it a poor choice. If your aim however, is suicide, you may just succeed – but – you will not fall peacefully asleep and slip quietly from the lives of those who care for you…………… It will not be simple. It will not be fast. It will not be beautiful.
It commonly plays out like this……….

You carefully calculate your personal quantity of medication required for fatal overdose.
You find a quiet spot and take it in exactly the manner you believe will achieve best results.
You don't throw up. You congratulate yourself on a job well done.
You feel settled, at peace, happy that at least now your pain will end.

BUT IT HASN'T ENDED –
THING IS –
IT HAS JUST BEGUN………

You see, you have set the wheels in motion but it will take up to 5-7 days for you to die.
Yes, you read that right – Up to 5-7 days !!! – In fact some suffer longer.
You get 12-24 hours symptom free (well, with perhaps exception of mild stomach pains or nausea)
Time goes on…..
You are still ok with the whole dying thing and wait for the end thinking "This isn't too bad”
You don't feel like eating but, you remind yourself it hardly matters now.
You get a really embarrassing dose of diarrhoea but you think "Could be worse”
You begin to feel a little weak and confused and again you think "This isn't too bad”
But
The Stomach cramps start to get a lot lot worse. You worry.
You notice your eyes look weird and your skin is a funny colour.
You begin to doubt yourself. You begin to think twice.
You are suddenly very scared.
The pain is getting worse –
You decide to go to a hospital…….
Or someone finds you and brings you in.
Now, there is a very effective antidote for Paracetamol overdose – Good news you think –
I'll get some treatment and put this whole stupid mess behind me – get on with my life.

But NO

You see, even though you don't actually feel that bad,
Even though you've now changed your mind,
Even though,
You want to live…………………
It's too late – it's been over 24 hours now -the damage is irreversible –
The antidote can't help.
Your kidneys WILL fail.
Your overwhelmed liver WILL fail.
The coma offered by other medications in overdose is rarely present with Paracetamol.
You will be fully awake, fully alert and fully aware as death stalks you.

You may no longer WANT to die,
But you WILL die.
It will be very painful and very emotional and very scary and very, very horrible.
It doesn't matter how well you feel right now,
It WILL happen
And there is nothing you can do about it.

You get to live out your very last 2-5 days lying in a hospital bed, in excruciating pain as your kidneys and other internal organs continue to shut down, and, as a parting gift, you give your loved ones the opportunity to sit helpless at your bedside for those 2-5 days watching it all play out. You may experience hypoglycaemia and distressing breathing difficulties. The pain meds may stop working. There just aren't enough words to describe how you feel – there aren't enough tears to make it better - you know you did this to yourself – you know you want to live – you know the liver transplant idea couldn't deliver. Suddenly, you know that the romantic death you dreamt of, has turned into nightmare of unbearable mental and physical pain. You want to scream. You do scream. You don't know what to say to the people around your bed – you never planned for this – This isn't at all how it was supposed to go.
This is harrowing and cruel and scary and your last moments will be full of thoughts about how it was all your own fault and wishes that you'd never lifted those pills in the first place. Every time you close your eyes you hope it's all a surreal dream but then you open them , straight into the eyes of your mother, or husband or child and it breaks your heart to see those tears.

What about the best case scenario?
If you get to a hospital with 12 hours the antidote WILL work, you will recover, you WILL live. You can be treated with laxative or activated charcoal or the antidote. Your liver will repair itself in a matter of weeks and life will go on. Even up to 48 hours after ingestion, the intravenous antidote will still be tried – even this far in there is good reason for hope. You will no doubt be referred for psychological assessment but you could find this a positive experience.

A considerably large percentage of people admitted to hospital with Paracetamol overdose do live, but now that you know what can easily happen, do you still want to take the chance?

Not sure?

Read on………..

6 quoted stories….
#1
I'm driving on this particular shift, my crewmate is in the back dealing with the patient.
I'm grinding my teeth at the waste.
The patient is almost certainly going to die - he's taken an overdose. The tablets he's taken, and the way he's taken them, mean that parts of his body will start to fail over the next few days. His immediate future is hospital bed, then an ITU bed, then either waiting for a transplant or death.
It's too late for any treatment to work on him.
He's not in any pain, he doesn't feel weak, he has no symptoms.
He talks to my crewmate. The body language suggests that he is upset but not suicidally depressed.
It was one of those 'cry for help' things - asking why he did it gets the answer that he wanted to die, but now they don't. It's a common enough reason - that they change their mind and then phone us.
Everyone can get these pills - you can read the inference, how can they be that dangerous if you can buy them over the counter?
He lives in a nice house, has a family, had his future ahead of him.
I suspect that he thinks that they'll have a 'stomach pump', a chat with the psychiatrists and then come home. He doesn't realise the damage that he has done to his body.
We don't talk about the outcome to the patient - we'll leave that to the hospital after his blood tests show if he is telling the truth or not. We'll only see him for the ten minutes it takes us to drive him to hospital.
I'm hoping that the patient is lying, that he hasn't done what he says he has, but the empty pill packets speak for themselves.
I know I'll be thinking about him for the next few months long after I've forgotten his name.
His mother is travelling with him.
He's fourteen years old.
(An entry from a 3rd party blog called ‘Random acts of reality' (circa 2008 - now discontinued)

#2
Perhaps the most horrifying aspect of this kind of OD is that some patients having taken an OD & having been taken to hospital think, they will survive. Only to be told by the doctors that death is certain & that nothing can prevent it now. So even were the OD was really a cry for help the outcome is certain death.
(Source unknown)

#3
The person goes into liver failure - then often bleeding = multi organ failure. Only a fast liver transplant can sometimes prevent death but even so liver transplantation can go wrong and livers can be rejected. Even if a liver transplant is successful the person would be on anti rejection drugs for life post operatively.
(Source unknown)

#4
A teenage girl accidentally killed herself after taking painkillers in a 'cry for help' when she was dumped by her childhood sweetheart. (K), 16, took the overdose in her bedroom hours after boyfriend (A), 19, ended their relationship. However, the pills had no immediate effect and she later met up with friends and admitted she had attempted an overdose to 'scare' (A). But when she returned home she collapsed in agony and died 11 days later in hospital from organ failure and brain damage.
(Dailymail newspaper - 2010)

#5
"The Sunday before she died my daughter phoned, complaining of severe stomach pains, which was unusual because she was an athlete all her life and in perfect health," says Donna. "I told her to go to the hospital but no one could take care of the baby—she was a single mom and they lived in Virginia. On Wednesday, she phoned again and said, 'All I can do is get up and feed the baby,' so the pain was worsening. About 2 am her neighbour called: they had taken her to hospital and they had the baby. Two hours later a doctor called.
"'Her liver has given up and I'm not sure that she is going to make it,' he explained to me. Frantically, I booked the first plane out. He called again at 10 am. 'We don't think she will make it but we are trying to keep her alive to see if a donor becomes available [for a liver] and then we will fly her to another hospital.'
"I was going nuts. He called back and said, 'If you want to see her alive you had better come now.' I couldn't get a direct flight; I knew it would have been faster to drive there but I couldn't drive, I was a nervous wreck."
Donna got to the hospital at 9 pm—her daughter had passed away one hour earlier.
(J Mundy – 2012)

#6
Ashley Campbell had a big heart.
She was sensitive, kind and caring. She loved dancing. She had many friends. She was beautiful.
"She was the best chocolate chip cookie-maker in the whole world," said her father, Chuck Campbell, a smile momentarily lighting up his face.
But grief sags his shoulders, as he, his wife Tammie and daughter Jessie look to the black and white portrait of Ashley on their fireplace mantel.
Ashley died June 25 from an overdose of acetaminophen, more commonly known by the brand name Tylenol (or Paracetamol).
"Her heart was so big it was the only organ that kept beating on its own," he said.
Chuck and Tammie spent four days at Ashley's bedside, watching her die of liver failure.
"If I had an enemy I wouldn't wish those four days on him," Chuck said.
They hope that by sharing Ashley's story, they can make people aware that a common, over-the-counter drug can cause liver damage and death.
They hope they can prevent the painful death their daughter endured.

Ashley and her best friend Julia Stuckenberg would eat waffles with peanut butter and syrup and watch Art Attack the mornings after their frequent sleepovers.
It was Ashley's favourite show, and she'd make little presents for Julia, placing pictures in little boxes she'd made out of old Christmas cards.
"She was really sweet," said Julia, 18. "She was nice to everybody."
Ashley discovered her aptitude for hairdressing after cutting Julia's hair in Grade 9. "She was really good at it," Julia said. "I haven't had anyone else cut my hair since Grade 9 or 10.
"It still amazes me how she could cut her own hair."
Jessie, Ashley's younger sister, also lent her hair to Ashley to practise her skills while attending the hairdressing course at Malaspina University-College.
Ashley permed, then later added bright red streaks to Jessie's sandy blond mane.
"We were going to freak our dad out and make him think it was a mohawk," Jessie said.
Ashley was an avid dancer, and would bring friends home to choreograph dance numbers.
Ashley took those dances to competitions in Port Alberni, talent shows and variety shows. She taught her routines to physical education classes at Nanaimo District secondary school and won an award for all her efforts.
"Dance was a big part of her life," Julia said.
As a child, Ashley wanted to be a veterinarian but was too sensitive to the pain the animals would experience at her hands.
"She was the kind of kid that would cry at Lassie," Chuck said. "When she got older, she knew she couldn't operate - it would be too painful for her."
Outwardly, she was always in a good mood, always cheerful.
"She was always happy," Julia said. "She did a really good job of hiding it."

Ashley wasn't eating or drinking properly, which signalled a problem to her friends and family.
After receiving a call from Ashley's roommate, concerned at the teen's health, Tammie confronted Ashley and she admitted taking Tylenol.
Tammie found an empty bottle in the bathroom.
"We packaged her up and took her to the hospital," Tammie said.
They didn't think it would take her life.
"She took an overdose of Tylenol - so what?" said Chuck, a retired RCMP officer. He told himself "We got you in lots of time and you're going to be fine."
Acetaminophen, commonly referred to as Tylenol, causes the liver to produce a toxic metabolite during breakdown of the drug. In high doses, it can cause liver damage, liver failure and death.
Doctors at Nanaimo Regional General Hospital immediately airlifted Ashley to Vancouver.
"Tammie fell into my arms and said, 'our daughter's dying'," Chuck said.

They stayed by her side at the Intensive Care Unit at Vancouver General Hospital.
They watched as her liver shut down, sending toxins through her blood, causing excruciating pain and swelling.
"She'd sit bolt upright, screaming," Chuck said. "They had to give her paralyzing drugs."
Continual dialysis, clotting medicine, a ventilator and nearly every machine imaginable was used to help prolong Ashley's life long enough for a liver transplant - one that would never come.
"The only thing keeping her alive was the machines," Chuck said. "We had to make the decision to take her off life support."
They stayed by her side as her heart slowly stopped beating.
"She didn't take a breath on her own," said Tammie.

They didn't linger at the hospital. They had to get home to Jessie, who was staying with friends.
"There was no way I was going to have them tell her that she'd lost her sister," Chuck said.
Ashley took medication for depression relatively common among teens.
She didn't live at home, but her family still kept an eye on her. To everyone who knew her, she seemed fine.
"I drove by [her apartment] just to see if I could see her," Chuck said. "I didn't want her to see Dad in the parking lot checking up on her."
Adding to her emotional sensitivity and sadness was a rift with her boyfriend.
It's some consolation to her family that Ashley didn't intend to kill herself. They're convinced from what she could briefly tell them that her intent was to block out her emotional pain for a few hours.
"In some small measure that's kind of helpful," Chuck said.
Chuck and Tammie taught their daughters safety and respect, giving them the tools to decide their actions for themselves.

"Nowhere in that equation did we think about mental illness or suicide," Chuck said. "If it can happen to us, it can happen to anyone."
Ashley said to a close friend that she'd never felt so alone, but the church where her celebration of life was held was filled to capacity.
"I don't think she knew how much she was loved by her family," Chuck said.
Support from friends and family have helped the Campbells cope with their loss.
"Everyone is sharing this grief with us," Chuck said. "I don't know how, but somehow it feels better."
They're encouraging of Ashley's friends to share their memories with them.
"They have to heal as well," Tammie said.

What to do if an overdose is suspected….
Contact the emergency services.
It is important to act even if there appears to be no symptoms.
Time is of the essence – effective treatment is dependent on early presentation at A&E.
Try to gather the following information –

Patient's age, approx weight and current condition.
Name of the product/s taken and strength.
If you have the bottle, bring it with you.
Time ingested.
Amount ingested.

Uk help for the suicidal….

Samaritans
• 08457 90 90 90* (UK)
• 1850 60 90 90* (ROI)
jo@samaritans.org
• Write to Freepost
RSRB-KKBY-CYJK, Chris, PO Box 90 90, Stirling, FK8 2SA

Lifeline
People living in Northern Ireland can call
0808 808 8000

(If you live in the US, please email me the appropriate contacts for two major helplines )
(I will then update this section of the blog)

(Similarly, if you have a personal story you would like included in my ‘quoted stories' section email me with details – I can accommodate a couple more)

bipolarlainey@hotmail.co.uk

Selected Twitter comments relating to this post....
#1 My 'fantasy' has always been paracetomal overdose, go to sleep, don't wake up - I can't thank you enough for writing this
#2 Apparently paracetamol overdose is one of the most painful ways to go....
#3 Excellent info about the truth of the agony of paracetamol overdose (retweeted). Pass it on & save lives.
#4 The terrible thing is you can get paracetamol with the 'antidote' built in. Not done tho cos of cost!
#5 I didn't know that. Should be compulsory regardless of cost. Think of the lives that could be saved.
#6 Knew it wasn't good n that you bleed from every orifice (think that's a myth) but didn't realise it's that bad! Thanks
#7 That's great as I thought that's what happened easy & go to sleep,jst shows you as I thought it would be just a sleep :/ xxx