The fatal paracetamol dosage--how low can you go?

Popular texts and forensic literature pertaining to paracetamol toxicology advocate an acceptable minimal dose or lower limit of the blood level 'normally' associated with a fatal single overdose. A case of fatal, acute paracetamol poisoning from a minimal single dose, within the recommended therapeutic daily total and associated with a zero blood paracetamol level, is reported. It also emphasizes the common knowledge that the toxicological tabulated reference data available on fatal levels of most drugs is merely a guide. The proper interpretation of the analytical results thus requires the full consideration of the circumstances surrounding the death in each case. The clinico-pathophysiology and toxicology of paracetamol poisoning is briefly reviewed in an attempt to establish how low a fatal paracetamol dosage can go. The phenomenon of fatal dose and blood level is in a paracetamol limbo.