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You are running a high fever or have a massive headache, so know you are going to max out at 4g/day. At that point, it's kind of hard to keep track of the clock.

"My head is pounding. Shit...did I take this at 3PM or 5PM? I know I took it and then fell asleep, but I can't remember when. It is now 9PM, can I take more or not?"

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It often happens when people take the max dose of straight paracetamol, and then also take another drug that has paracetamol in it without knowing that (e.g. a codeine/paracetamol or ibuprofen/paracetamol combination).
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People who are in a lot of pain and don’t know the risks.

Rationalizations like “they probably put the limit way lower than the real limit so idiots don’t OD themselves, so I can safely take a bit more” become very attractive when you’re in a lot of pain.

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To be fair, the "real" limit depends on how lucky you are with your body's makeup. The safe limit is below that limit.

I know people with permanent pain due to medical conditions who have been given a doctor's approval to exceed the limits printed on the packaging (after having previously been monitored). You can exceed the limit on the packaging by one or two pills.

A bit more is often not deadly, but it's very easy to take more than a bit. When I had a messed up mouth for several days, I took the maximum doses and set timers to help me regulate the dosage throughout the day, but I sure wished I could've taken more at that time.

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Okay that's right, if you just keep upping the dose because you're still in pain it might be easy to just slam a few every 4 hours

From personal experience if i have a headache I'll take 1000 mg all at once; it either works right away or it doesnt and I stop bothering until I've had a good nights rest...

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Imagine if that rest will do nothing for that headache and its there morning day and night. Or some injury-related pain which simply can't be downtuned. Plus when old, half of the body aches, all old injuries and general deterioration.

I had only very brief experiences with longer intense pain but it made my mind into pudding and desperate knot of how-to-stop-this-at-all-costs. Normal life is not possible and sanity is not granted.

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Yah...I've been there for 6 months now with a constant headache. The first month or so, I was taking 3.5g/day consistently. At hour 4.5 - 5, it would wear off. If it wasn't for my tracking, I probably would have ODed.
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If you take 2 on average every 4 hours, you're at 12. If you're feverish or otherwise feeling ill enough and sleep deprived enough, forgetting when you took them last is easy. Personally I write down the time I took the last one.
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It can also happen if the person has some disease that affects the liver, which in turns lowers how much of the drug they can take.
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Hot Coldrex (Tylenol) + Pills. People don't read.
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