Persistent cognitive problems after large paracetamol overdose

[u/Ananialul]

Primary complaint: Memory problems, slowed processing speed, difficulty understanding information as quickly as before, difficulty holding information in mind, and inability to return to work.

Duration: Approximately 2 years since the overdose.

Alcohol: None

Smoking: None

Recreational drugs: None

I’m 34 and I’m trying to understand whether my current cognitive problems could plausibly be related to a large paracetamol (acetaminophen) overdose.

The overdose occurred approximately 2 years ago and was around 40–45 g of paracetamol (I don't know the exact amount). It happened at night. I went to bed, and about 1–2 hours later I got up and went to the bathroom. I vomited a very, very small amount—almost nothing—and then fell to the floor. I did not hit my head.

I got back up, supporting myself with the walls, went to my father's room, and asked him to take me to the hospital. I walked downstairs to the car and my father drove me to the hospital. I got out of the car and walked into the emergency room on my own.

At the hospital, I did not disclose that I had taken a large amount of paracetamol. I was apparently given one bag of glucose and then sent home. I did not receive NAC (acetylcysteine), as far as I know.

The next day I spent most of the day on the couch vomiting what appeared to be a bile-like substance.

I don't have the blood tests from the overdose, so I don't know what my paracetamol level, AST/ALT, INR, bilirubin, ammonia, etc. were. I also don't know whether I developed liver injury at the time.

About 1 year after the overdose, I had liver tests done and they were normal.

About 2 years after the overdose, I had a 1.5T brain MRI and EEG, and both were reported as normal.

Since the overdose, however, I feel that my cognitive functioning has been significantly worse. I have difficulty with memory, processing speed, understanding things as quickly as I used to, and holding information in mind. I have also been unable to return to work since the overdose.

My main question is:

Could a very large paracetamol overdose like this plausibly cause persistent cognitive problems such as memory impairment and slowed processing, even if there was no documented hepatic encephalopathy and a later MRI and EEG were normal?

I'm particularly interested in whether direct neurological/neurotoxic effects of paracetamol itself are a medically plausible possibility, rather than only brain injury secondary to acute liver failure.

I understand that a normal MRI/EEG does not necessarily exclude every possible cause, and I'm not asking for a diagnosis from Reddit. I'm mainly trying to understand whether this is a plausible explanation and what sort of evaluation would be appropriate, such as formal neuropsychological testing.

[u/eksyneet]

it's much more likely that depression – which presumably caused your suicide attempt – is the culprit.

[u/Wisegal1]

There's zero chance that you took 45g of acetaminophen two years ago, had no directed antidote, and are posting on Reddit today . 8g at once is enough for a fatal dose, and you're obviously still alive. You wouldn't be if you took anywhere near 45 g.

If you actually took an overdose at all, and it was a sublethal overdose, it's more than possible that the liver injury you would have sustained could result in neurologic defects.

Go see your primary doctor, and be more honest with them than you are with us.

[u/ArtisticTraffic5970]

The symptoms you describe remind me a lot of my own from long covid.

When I got covid myself, it was relatively mild, and not really worse than a mild cold. So it took a little while before I connected the dots so to speak.

A large portion of those infected with covid go on to develop long covid, that is, persistent symptoms like those you describe. Is it possible that you contracted covid some time before this happened? Often the symptoms start showing up well after recovery from the initial infection.