The association between paracetamol overdose and
prolonged prothrombin time due to hepatic failure is
well recognized. However, little is known of the possibility
that paracetamol overdose can prolong the prothrombin
time without overt hepatic failure. The few data from
the literature suggest this is either due to a reduction in
the functional levels of the vitamin K-dependent clotting
factors by elevated doses of paracetamol, or a consequence
of the administration of the antidote N-acetylcystein.
The three reported cases provide further evidence
that paracetamol overdose can be associated with aprolongation in the prothrombin time without overt
hepatic failure. Even though the prothrombin time provides
useful prognosis information, decisions regarding
the management of these patients should not solely be
based on this endpoint to avoid misinterpretation of the
accuracy and the severity of liver failure.