Not All Overdoses are Intentional: A Case of Unintentional Paracetamol Toxicity

Author: Luke O’Neill / Editor: Steve Corry-Bass / Codes: PhC1, PhP2, PhP3, SLO1, SLO2 / Published: 08/08/2025

A 46-year-old male self-presents to the Emergency Department (ED) with 3 months refractory headache and subacute forehead swelling (unknown duration) with acute periorbital oedema.

Noted blowing nose would result in further pain along with blood and thick green mucous discharged.

GP phone review 2 months prior, advised regular analgesia and prescribed sumatriptan.

Pain refractory to these medications, stopped taking sumatriptan and unknowingly taking overdose of paracetamol – reported taking 4x 500mg tablets 3-4 times a day for last 2 months.

The patient weighs 80kg. He is eating and drinking well with no nausea or vomiting.

The patient reports no fevers or head trauma. He has no visual disturbance, no pain with eye movements, no LOC episodes no lower limb oedema, no paraesthesia or loss of power in upper/lower limbs. No other concerning symptoms on systematic history has been reported.

Swelling over forehead and mid brow is noted – 3x3cm. No fluctuance, but tender to palpate. Periorbital oedema B/L below eyes. B/L outer ear and ear canal examination shows no obvious abnormalities.

No obvious dental swelling or discharge on oral examination has been revealed.

GCS 15 with no neurology symptoms or signs on examination.

Abdomen is soft and non-tender. no jaundice.

No Significant PMHx other than heavy smoker. The patient exercises regularly.

Lactate is normal on point of care VBG.