The Use of Methionine for Acute Paracetamol Poisoning

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Abstract
Since September 1974 the London Centre of the National Poisons Information Service has advocated the use of methionine for acute paracetamol poisoning and this paper presents a preliminary report of its outcome. Seventeen patients, all of whom had high plasma paracetamol levels, received oral methionine within ten hours of the ingestion of the overdose. Eleven of these patients suffered no hepatic damage, while the remaining six showed varying degrees of liver failure with a mean maximum aspartate aminotransferase (AST) of 1,098 iu/l. There were no deaths in this group. Among fourteen patients who had taken similar paracetamol overdoses and received no antidotal treatment, all developed liver damage and seven of these died. These two groups were not, however, accurately matched for dose of paracetamol, plasma paracetamol levels or interval before reaching hospital. Comparison was therefore made with two other recently published series of untreated patients. A significant reduction was noted in the incidence of liver damage and in the mean maximum AST. Although this survey was not controlled, it is suggested that oral methionine, which has a low incidence of side-effects, may be effective in reducing the incidence and severity of paracetamol-induced liver damage, provided the overdose is not massive.