If not promptly treated paracetamol overdose can cause potentially fatal liver damage it is the most common cause of acute liver failure and necessity for liver transplantation. Despite government initiatives to restrict over the counter sales 1, paracetamol remains the most common medicinal drug to be taken in overdose, accounting for a half of all drug overdose related attendances at UK hospital emergency departments 2. Chapter 14 is concerned principally with the latter, whilst this chapter is concerned with how laboratory measurement of serum or plasma concentration of salicylate and paracetamol contributes to the care of patients who have, or are suspected of having, taken a deliberate or accidental acute overdose of aspirin (acetylsalicylic acid) or paracetamol (called acetaminophen in the US). Such analyses are valuable in two usually separate clinical contexts: deliberate or accidental drug overdose and therapeutic drug monitoring. Clinical laboratory staff members are often requested to analyse blood or urine samples for the presence of specific drugs.
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