A paracetamolterápia és az idült májbetegség tragikus következményei.

During the cold season, many people use different OTC (over-the-counter) cold medicines, including a large number of paracetamol- (also called acetaminophen-) containing drugs. Paracetamol is a popular and widely used non-opioid analgesic, used to treat different types of pains as headache, migraine, period pain and pains associated with cold and flu. Paracetamol is available in various formulations such as tablet, suppository and hot drink. In Hungary, there are 86 paracetamol-containing products registered in 2020. When used as prescribed, paracetamol is safe and effective. In this paper, we present three cases, when paracetamol may have contributed to the cause of death. Each of the three patients - ages 34, 42 and 51 - were chronic alcoholics and after hospitalization, all of them died within a short time. In our investigation, nine serum samples from three patients were analysed. Enzymatic assay has been carried out for the determination of paracetamol and its metabolites (Roche assay), while supercritical fluid chromatography coupled to tandem mass spectrometry (SFC-MS/MS) was performed for the determination of paracetamol. We found therapeutic concentrations in every sample with enzymatic assay. Furthermore, we also analysed four samples from one patient by SFC-MS/MS in which the measured concentrations were lower than the minimum effective concentration. Paracetamol use by chronic alcohol abusers may carry an increased risk. Results of paracetamol enzymatic assay used in clinical toxicological practice should be evaluated together with the liver and kidney function tests, because even paracetamol concentrations within the therapeutic range cannot exclude its toxic effect.