A new study has revealed a significant increase in liver injury cases linked to exposure to drugs, alcohol, dietary supplements, and other substances.
The study indicated that paracetamol, a common painkiller available without a prescription, was the substance most frequently associated with these injuries over the past 25 years.
Researchers in Virginia analyzed data from about 220,000 cases of liver injury reported by poison control centers in the United States between 2000 and 2024, and found that the rate of injuries caused by all substances increased from 10.9 cases per million people in 2000 to 52.9 cases per million at the end of the study period, more than four times.
In 2000, there were approximately 2,400 cases of liver injury annually caused by toxic substances, before the number rose to approximately 14,500 cases by 2021, an increase of approximately 500%.
More than 80% of the reported cases required hospitalization, while deaths were recorded in about 6% of them, reflecting the seriousness of some cases of liver injury associated with poisoning or overdoses.
Paracetamol, known in the United States as "acetaminophen" and the active ingredient in the drug "Tylenol," was the substance most frequently associated with liver injuries during the study period.
Paracetamol has been linked to approximately 45% of reported liver injuries among women and 33% of cases among men.
Dr. Christopher Holsteg, the emergency physician overseeing the study, said that liver injuries reported to poison control centers in the United States have been steadily increasing, noting the importance of public awareness of the potential for liver damage when using readily available consumer products.
Paracetamol is widely used to relieve pain, such as muscle aches, and is also an ingredient in a number of medicines used to relieve the symptoms of colds and flu.
When used in the recommended doses, the drug is safe and effective, but taking larger amounts than the specified dose may lead to its accumulation in liver cells and cause severe, potentially permanent, damage
Symptoms of an overdose include nausea, vomiting, abdominal pain, mental confusion, and jaundice, which manifests as yellowing of the skin and whites of the eyes. In severe cases, the damage may necessitate a liver transplant or result in death.
The study showed that paracetamol-related injuries decreased during the second decade of the millennium, after the number of drugs combining paracetamol with other pharmaceutical substances on the market was reduced, but they subsequently rose again.
These combination medicines include painkillers containing paracetamol along with hydrocodone or oxycodone.
The researchers pointed out that some cases of poisoning occur unintentionally, when a person takes paracetamol and then uses another drug without realizing that the second drug also contains the same substance, which may lead to exceeding the recommended dose.
Alcohol came in second among substances associated with liver injuries in the study, accounting for 19% of reported cases among men and 13% among women.
Researchers also identified cases linked to dietary and herbal supplements and environmental toxins, but these were less common compared to paracetamol and alcohol.
The researchers found that suspected suicides using paracetamol were the most common cause of liver injury in both men and women.
Holsteg said the significant increase in reported liver injuries over the past 25 years, along with the growing role of paracetamol, underscores the importance of poison control centers in monitoring poisoning cases and tracking related trends.
He stressed the need to use medications according to doctors' instructions and drug leaflets, while exercising caution when using new or unregulated substances.
The study is scheduled to be published in the journal "Clinical Gastroenterology and Hepatology".
