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Management of poisoned patients was difficult as maximum abnormalities of liver function were delayed for 3\u00a0days or more after an overdose. There was no treatment and the mechanism of hepatotoxicity was not known. The paracetamol half\u2010life was prolonged with liver damage occurring when it exceeded 4\u00a0h and the Rumack\u2013Matthew nomogram was an important advance that allowed stratification of patients into separate zones of risk. It is used to guide prognosis and treatment and its predictive value could be increased by combining it with the paracetamol half\u2010life. The problems of a sheep farmer in Australia in the early 1970s led to the discovery of the mechanism of paracetamol hepatotoxicity, and the first effective treatment of overdosage with intravenous (IV) cysteamine. This had unpleasant side effects and administration was difficult. <jats:italic>N<\/jats:italic>\u2010acetylcysteine soon became the treatment of choice for paracetamol overdose and given early it was very effective when administered either IV or orally. <jats:italic>N<\/jats:italic>\u2010acetylcysteine could cause <jats:italic>anaphylactoid<\/jats:italic> reactions, particularly early during IV administration when the concentrations were highest. Simpler and shorter regimes with slower initial rates of infusion have now been introduced with a reduced incidence of these adverse effects. In addition, there has been a move to use larger doses of <jats:italic>N<\/jats:italic>\u2010acetylcysteine given over longer periods for patients who are more severely poisoned and those with risk factors. There has been much interest recently in the search for novel biomarkers such as microRNAs, procalcitonin and cyclophilin that promise to have greater specificity and sensitivity than transaminases. Paracetamol\u2013protein adducts predict hepatotoxicity and are specific biomarkers of toxic paracetamol metabolite exposure. Another approach would be measurement of the plasma levels of cysteine and inorganic sulfate. It is 50\u2009years since the first effective treatment for paracetamol poisoning and, apart from liver transplantation, there is still no effective treatment for patients who present late.<\/jats:p>","DOI":"10.1111\/bcp.15903","type":"journal-article","created":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T22:08:38Z","timestamp":1694210918000},"page":"127-134","source":"Crossref","is-referenced-by-count":32,"title":["Paracetamol (acetaminophen) poisoning: The early years"],"prefix":"10.1111","volume":"90","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-0133-9415","authenticated-orcid":false,"given":"Laurie F.","family":"Prescott","sequence":"first","affiliation":[{"name":"Emeritus Professor of Clinical Pharmacology University of Edinburgh  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,9,21]]},"reference":[{"key":"e_1_2_11_2_1","first-page":"29","article-title":"The fate of acetanilide in man","volume":"94","author":"Brodie BB","year":"1948","journal-title":"J Pharmacol Exp Therap"},{"key":"e_1_2_11_3_1","first-page":"58","article-title":"The fate of acetophenetidin (phenacetin) in man and methods for the estimation of acetophenetidin and its metabolites in biological material","volume":"94","author":"Brodie BB","year":"1948","journal-title":"J Pharmacol Exp Therap"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.2.6140.832\u2010c"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003\u20104819\u201087\u20102\u2010202"},{"key":"e_1_2_11_6_1","volume-title":"Aspirin and the salicylates","author":"Rainsford KD","year":"1984"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.1.6105.90"},{"key":"e_1_2_11_8_1","volume-title":"Paracetamol (acetaminophen)","author":"Prescott LF","year":"1996"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.2.5512.497"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u20100773.1964.tb01784.x"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1476-5381.1966.tb01841.x"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.3.5722.557"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1971.03190160088021"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.2165\/00003495-198325030-00002"},{"key":"e_1_2_11_15_1","first-page":"357","article-title":"Henry Matthew: the father of modern clinical toxicology","volume":"39","author":"Proudfoot AT","year":"2009","journal-title":"J Roy Col Phys Ed"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(71)91125\u20101"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1476\u20105381.1973.tb08536.x"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1067\/mcp.2002.121857"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.55.6.871"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1081\/CLT\u2010120002882"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.12604"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1080\/15563650.2018.1529320"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/FTD.0000000000000995"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(74)92649\u2010X"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.62.5S.898"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.12362"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1159\/000136226"},{"key":"e_1_2_11_28_1","first-page":"185","article-title":"Acetaminophen\u2010induced hepatic necrosis. 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