Could you be overdosing on paracetamol? It’s everyone’s quick fix for aches and pain but you’ll be shocked how easy it is to take too much


Watching her four children cause havoc in the living room with piles of Lego, dolls and colouring books, Lesley Gerdes smiles.

‘What’s a bit of mess?’ she asks happily.

Lesley cherishes every moment with her children — Danny, ten, Maddison, nine, Chelsea, six, and Isla, 18 months.

That’s because just after Isla was born, Lesley nearly died as a result of an accidental overdose of paracetamol.
‘I knew from previous pregnancies that it was safe for me to take paracetamol,’ said Lesley Gerdes

When she was pregnant with Isla, Lesley had developed pelvic girdle pain, a condition where the pelvis becomes misaligned, often causing the bones to slip out of place.

Up to one in four pregnant women suffers from it, and it can be excruciatingly painful.

Lesley had had pelvic girdle pain with her previous pregnancy, but this time it was much worse.

‘Some days I could barely get up or even hobble to the bathroom,’ says the 29-year-old mother from Helensburgh in Argyll and Bute.

Her GP prescribed co-codamol, a strong painkiller.

Lesley, who was living in Plymouth at the time, took the medication at the recommended intervals of four times a day.

And in between doses, she also took paracetamol — up to the standard four doses a day — to keep the pain at bay.

‘I felt so bad just lying on the sofa in pain — taking the painkillers meant I could get up and play with Danny and Maddison or hobble to the kitchen and actually prepare a meal,’ she says..’

But what Lesley didn’t know was that co-codamol contains paracetamol, and that by combining it with the otherwise innocent over-the-counter paracetamol, she was slowly, but surely, giving herself a life-threatening overdose.

The risks became frighteningly real when she was 36 weeks pregnant and suddenly started getting contractions.

‘I’d had three children and initially I thought they were just Braxton Hicks — the “practice” contractions you get,’ she says.

‘My midwife told me they often seemed much stronger the more pregnancies you have, so I put it down to that.’

But when the contractions didn’t stop after a few hours, the midwife sent Lesley to hospital to be monitored.

‘I was shocked — I’d never dreamed I’d been overdosing on the pills,’ said Lesley (with Isla)
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‘I was shocked — I’d never dreamed I’d been overdosing on the pills,’ said Lesley (with Isla)

‘I was put on a machine to check the baby’s heartbeat,’ she says.

‘I thought I’d be told all was well, but the doctor monitoring me looked very grave.

‘He came back with another consultant and they said my baby’s heart was beating erratically and she needed to be delivered that night.’

Her partner rushed home to arrange childcare for the other children while Lesley was wheeled off to theatre for an emergency Caesarean.

‘I was so frightened,’ she recalls.

When Lesley came to, she was in the recovery room, with a tube down her throat to help her breathe.

At that moment a doctor appeared and told Lesley her baby, Isla, was alive, but in special care.

‘Then he told me I hadn’t woken from the anaesthetic for two days,’ says Lesley.

As that news sank in, there was more to come; a paediatrician came to Lesley’s bedside to say Isla was very ill — her liver wasn’t functioning properly and she was jaundiced.

‘He said they didn’t know what would happen, but that they were doing all they could,’ she says.

Isla was too ill to leave the high-dependency unit and Lesley herself, who was dropping in and out of consciousness, was too ill to see her.

‘I felt so weak,’ she recalls. ‘I longed to see Isla, but could barely keep my eyes open.’

In fact, Lesley was now desperately ill and her liver was starting to fail.

Fearing she could die, Lesley’s doctors summoned her whole family — her parents Linda and Allan, her sisters and brother — to see her.

‘People kept coming in and crying and hugging me,’ she recalls. ‘I knew something was very wrong, but no one knew why I was so ill.’

Then, a few days after Isla’s birth, a doctor literally came running to Lesley’s bed.

Toxicology reports had shown a massive amount of paracetamol in both her liver and in her baby’s and he asked her angrily if she had taken an overdose.

‘I was stunned. I thought I was imagining it. But I said of course I hadn’t overdosed. But then another doctor rushed up, looking just as angry.

THAT EVENING GLASS OF WINE MAY RAISES YOUR RISK
At-risk groups include big drinkers, and those taking anti-convulsants or St John’s Wort

At-risk groups include big drinkers, and those taking anti-convulsants or St John’s Wort

Paracetamol is safe when taken in the recommended amount.

However, over these limits it can trigger liver damage.

Unfortunately, some people are more susceptible to paracetamol and don’t need to take as much to suffer problems.

Professor Kevin Moore, a consultant hepatologist and professor at University College London, says: ‘Many years ago we thought that it took a lot of paracetamol to cause toxicity in the liver and lead to acute liver failure — but the fact is everyone reacts differently to different levels of paracetamol.’

This is caused by how much of a key enzyme called P450 2E1 we have in our livers.

This enzyme determines how much paracetamol is metabolised.

Certain people may be more susceptible to paracetamol even at standard doses, says Dr Phillip Harrison, a consultant hepatologist at the London Liver Centre.

At-risk groups include big drinkers, and those taking anti-convulsants (such as for epilepsy) or St John’s Wort, the herbal remedy used to tackle mild depression.

Professor Moore explains these drugs and alcohol can affect levels of the P450 2E1 enzyme — warning that some people don’t have to be drinking a lot (ie, five units a day, or the equivalent of half a bottle of wine) to be affected.

Others at risk are people who have a low body mass index or are malnourished — perhaps following surgery, or because they have an eating disorder or are elderly — or have an inflammatory bowel disease or cancer.

All these conditions may result in low stores of liver glutathione — an antioxidant that helps prevent cell damage.
‘He said: “How many did you take? You have overdosed, haven’t you?” He was actually raising his voice.

‘Then another doctor started repeatedly yelling: “How many did you take, how many did you take?” I started crying — I kept telling them I hadn’t overdosed, but no one believed me.’

Then one of the doctors told Lesley she’d almost certainly need a liver transplant or she’d die.

In the haze of semi-consciousness and the raised voices, Lesley suddenly remembered she’d taken paracetamol with her co-codamol pills — when she told the doctors, they said she’d been overdosing on paracetamol accidentally for six months.

And little Isla had been exposed to such a high amount of co-codamol in the womb, she had been born addicted.

‘I was shocked — I’d never dreamed I’d been overdosing on the pills.’

When taken at the correct dosage, paracetamol should be perfectly safe.

However, the danger is when it is inadvertently combined with other treatments that also contain the drug, such as combination painkillers like co-codamol, or over-the-counter remedies such as Lemsip for flu.
This overwhelms the liver’s normal pathway for metabolising the drug safely, and instead it ends up in a toxic form which damages the cells, eventually leading to liver failure.

Initially there are often no symptoms, explains Kevin Moore, a consultant liver specialist and professor at University College London.

But once the liver is damaged beyond a certain point, very quickly — within 24 to 48 hours — you develop abdominal pain and vomiting, jaundice and liver failure.

It’s frighteningly easy to take too much paracetamol, as Jayne Wentworth discovered.

The recruitment consultant from Buckinghamshire had the flu and had been taking paracetamol for a couple of days.

However, on the third day, after taking a couple of paracetamol pills she also took Day Nurse to ease her symptoms. She had no idea the medicine contained paracetamol.

She then had her second dose of Day Nurse an hour or so before the recommended time and went to visit her in-laws.

‘I sat on the sofa and next thing I knew, everything went black,’ she says. When she woke up, four hours had passed.

‘My mother-in-law was frantic. She said I’d been completely comatose for almost four hours.

‘They’d tried rousing me, pulling up my eyelids, everything, but I was in such a deep sleep they couldn’t rouse me.’

Afterwards, Jayne was driven home, feeling drowsy and subdued.

‘I felt as if my heart was beating slowly and heavy in my chest,’ she recalls.

It was then the penny dropped and she looked at the Day Nurse bottle.

‘I shuddered to think what could have been,’ she recalls.

‘I’m lucky I was fit and sporty, as I think that’s possibly what made me bounce back from it so easily.’

Jayne is now extremely cautious with any medicine.

Watch as Leyla Hannbeck advises on paracetamol use

‘I always read the label to check if it contains paracetamol and ensure I write down exactly when I took the last dose,’ she says.

‘It seemed such a silly, small amount of paracetamol, but sometimes it doesn’t take much to have a big effect.’

This was highlighted by the tragic death of fitness instructor Donna Bishop.

The 25-year-old mother from Worcester died in January 2011 of an accidental paracetamol overdose after taking paracetamol, cough medicine and Lemsip for a cold she’d been suffering from for several weeks.

Her illness caused her to vomit a few times and she would then ‘top up’ the paracetamol she thought she’d purged by throwing up.

She was also prescribed co-codamol after complaining of pain due to mouth ulcers, and difficulty swallowing.

She developed jaundice and was unsteady on her feet, and was taken to hospital, where she later died.

Ten days after Isla’s birth, Lesley was finally well enough to meet her daughter and her baby was wheeled to her bed in an incubator.

‘Isla was still tiny — she weighed 5lb and I could barely see her for wires and tubes,’ says her mother.

‘I broke down and stroked her arm. I told her I was sorry . . . that I never meant to harm her . . .’ she recalls. ‘I felt so guilty. I could have killed us both.’

When taken at the correct dosage, paracetamol should be perfectly safe
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When taken at the correct dosage, paracetamol should be perfectly safe

But Lesley herself was still very ill and while Isla remained in Plymouth, she was transferred to King’s College Hospital, London, where she was told she would probably need a liver transplant.

First, though, liver specialists gave her antidote drugs to flush the paracetamol from her system — this worked, and within a couple of days, she was told she didn’t need a transplant after all.

Two weeks after she was transferred to London, she went back to Isla in the hospital in Plymouth.

‘It was amazing to see Isla. She was turning a corner, but was so addicted to co-codamol she had to have morphine to stop her shaking,’ Lesley says.

‘I’d sit at her side and cry. I felt like an idiot; like I’d failed her.’

After three more weeks in hospital, Isla was deemed fit to go home. ‘The relief was immense,’ says Lesley.

Dr Harrison adds: ‘To prevent accidental overdoses, it’s vital we have better labelling on products so people are aware that certain drugs or situations increase their risk of toxicity.’

Professor Moore agrees: ‘Labelling needs to be clearer on paracetamol and medicines which should not be taken alongside it.

‘It’s not always clear what contains paracetamol or what can react with paracetamol, so clearer labelling is very important.’

Lesley is now obsessive about reading the labels of any medication she or her children take and wants to warn others of the dangers of paracetamol and paracetamol-containing drugs.

‘Make sure you read the labels of all drugs and ask your doctor or pharmacist if you’re at all confused,’ she says.

‘Paracetamol overdose can creep up slowly, as it did with me. I nearly killed myself and my baby.’

Lesley herself seems to have suffered no lasting damage, although she must avoid alcohol and can never again take paracetamol.

Unfortunately, Isla has a six-month delay in her development and cannot yet walk or talk — doctors have told Lesley this is probably due to the paracetamol overdose. It is, says Lesley, unbearable to think her actions were responsible.

‘I should have read the labels. That’s my fault,’ says Lesley.

‘But I just didn’t think I had to worry about paracetamol — you just don’t, do you, unless something like this happens?

‘Don’t let it happen to you.’

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