Targets: This examination expected to decide the commonness of hypokalemia and its clinical associates in intense mental sickness among hypokalemic and normokalemic patients after acetaminophen overdose. Techniques: This is a review associate investigation of healing center affirmations for intense acetaminophen overdose led over a time of 5 years from January 1, 2004 to December 31, 2008. Statistic information and diverse kinds of mental disease were thought about among hypokalemic and normokalemic patients. Hypokalemia was predefined by a serum fixation < 3.5 mmol/L. SPSS 15 was utilized for information investigation. Results: Two hundred and eighty patients out of 305 confirmations were examined. Hypokalemia was found in 63.6% of patients with a higher commonness within the sight of mental sickness (67.7%). Hypokalemic patients were altogether connected with the nearness of significant despondency (P = 0.04), alteration issue (P < 0.001), uneasiness (P = 0.01), and self-destructive endeavors (P = 0.04). End: Hypokalemia was regular among patients with mental ailment and intense acetaminophen overdose. Catchphrases: Acetaminophen; Hypokalemia; Overdose; Potassium; Psychiatric ailment. Presentation Conscious self-harming (DSP) is perceived as a noteworthy reason for suicide around the world.1 Acetaminophen (Paracetamol) is the most widely recognized medication utilized in DSP in numerous nations, 2, 3 including Malaysia.4 Despite amazing security in restorative portions of acetaminophen; it is additionally one of the main sources of serious hepatic necrosis.5 Acetaminophen overdose might be joined by electrolyte aggravations including hypokalemia, and these give off an impression of being free of the hepatotoxic effects.6 These electrolyte changes have all the earmarks of being because of the expansion in fragmentary renal discharge of potassium, however the hidden cell systems by which acetaminophen may adjust electrolyte transport are still unknown.6-9 now and again, hypokalemia might be serious, achieving a level of 2.3 mmol/L after revealed ingestion of 48 g of acetaminophen.8 Hypokalemia, an effortlessly identifiable and clinically imperative condition in clinical settings, has gotten little consideration from analysts around the world. Not exclusively is hypokalemia related with successive cardiovascular and neuromuscular confusions, yet its impact on mental capacity may likewise fuel mental disturbances.10, 11 Both anxiety12 and exceptional exercise13 increment coursing epinephrine, which initiates a β2 – receptor-intervened deluge of potassium into skeletal muscle.14 As this condition might be like the intense insane state, it was guessed that the decrease in serum potassium fixation could be related with the nearness of mental ailment amid acetaminophen overdose. To enhance our insight into hypokalemia after intense acetaminophen overdose, we completed a five-year, healing center based examination with the accompanying destinations: 1) to decide the predominance of hypokalemia in patients introducing to doctor's facility after acetaminophen overdose, and 2) to research the clinical connects in intense mental ailment among hypokalemic and normokalemic patients after acetaminophen overdose. Strategies Settings and Study Design This is an observational review case survey of all patients with intense acetaminophen overdose admitted to a 1200-bed doctor's facility situated in the Northern area of Malaysia. The clinic gives medicinal services and crisis treatment for all sicknesses and mishaps. All parts of the examination convention, including access to and utilization of the patients' clinical data, were approved by the neighborhood wellbeing specialists before commencement of this investigation. Members and Data Collection Information were gathered from January 1, 2004 to December 31, 2008. A PC produced list was acquired from the Hospital Record Office. We distinguished our cases as indicated by the T-codes of the International Classification of Diseases-Tenth modification (ICD-10). All patients with analytic codes T 39.1 (acetaminophen overdose) were incorporated into the investigation. Uniquely structured information accumulation frames were utilized to gather information concerning age, sex, conditions of overdose (inadvertent or self-destructive), expressed date and time of harming to figure the idleness time (the season of ingestion to the time the patient was introduced at the clinic), amount of acetaminophen ingested, GI sterilization, for example, stomach wash, research facility tests including serum acetaminophen focus, and serum potassium fixations amid the principal day of confirmation and following at least 4 hours of ingestion. Information on serum acetaminophen fixation estimations were acquired from the healing facility's remedial medication observing research facility benefit. What's more, information identified with the nearness of mental disease were acquired. mental sickness was characterized as the nearness of any aggravation of enthusiastic balance, as showed in maladaptive conduct and disabled working, caused by hereditary, physical, synthetic, natural, mental, or social and social factors, for example, sadness, tension, modification issue, indiscreet practices and stress responses, either passionate or conduct; these causes were noted by the clinic mental expert report. Hypokalemia was characterized as a serum potassium level of under 3.5 mmol/L.11 Patients with hypokalemia were arranged into three gatherings dependent on potassium levels: (1) gentle/review 1 (3.0 – 3.4 mmol/L), (2) moderate/review 2 (2.5 – 2.9 mmol/L) and, (3) extreme/review 3 (< 2.5 mmol/L).15 The outlines of all patients recognized through the inquiry were investigated and the information gathered. Graphs were avoided from examination for the accompanying reasons: (1) gauge potassium fixations were not estimated, (2) if patients had taken acetaminophen but rather the reason for ingestion was obscure or undetermined, (3) the season of ingestion was not known or (4) the patients were on normal endorsed drugs that prompt hypokalemia, for example, furosemide, and (5) the patients were kids under 13 years old. Graphs of patients who had research facility tests at or over 4 hours post-ingestion were extricated for further examination. Factual investigation Information were entered and investigated utilizing the Statistical Package for Social Sciences program variant 15 (SPSS). Information were communicated as mean ± SD for nonstop factors and as recurrence for all out factors. The Chi square or Fischer's correct test, as proper, was utilized to test the hugeness between all out factors. The free examples t-test was utilized to think about methods for nonstop factors. Factors were tried for typicality utilizing the Kolmogorov-Smirnov test. Factors that were not ordinarily disseminated were communicated as a middle (lower – upper quartiles). Measurable centrality was considered at P < 0.05. Results Three hundred and five instances of acetaminophen overdose were recognized. Of these, 25 patients (8.2%) were prohibited. Benchmark potassium fixations were not estimated in eight patients, one patient was given furosemide at confirmation, five patients were under 13 years of age, the reason for ingestion was obscure or undetermined in 11 patients, and in this manner, the examination populace comprised of 280 patients (45 male and 235 female patients with a mean period of 23.4 ± 7.1, giving a female: male proportion of 5.22: 1). The larger part (72.1%) of instances of acetaminophen ingestion were introduced inside eight hours. The middle (interquartile extend) amount of acetaminophen ingested was 10 g (6 – 15 g). Introductory administration included stomach wash, which was performed in 181 (64.6%) cases. Enacted charcoal was given while patients were in the Accident and Emergency office; it was given as single or numerous portions in 173 cases (61.8%). Intravenous N-acetylcysteine (NAC) was given to 140 patients (half) after acetaminophen levels were assessed. The middle (interquartile extend) serum acetaminophen focus was 55.6 mg/L (14 – 120 mg/L). Amid the investigation time frame, 63.6% (178 patients; 33 guys and 145 females) had potassium levels of under 3.5 mmol/L. For the hypokalemic patients, the mean potassium level was 3.1 ± 0.26 mmol/L, while that for the normokalemic patients was 3.76 ± 0.35 mmol/L. The vast majority of the patients (129) were in gentle stage hypokalemia and 45 patients were in moderate stage hypokalemia. Barely any patients (4) were in extreme stage hypokalemia. Mentally sick subjects were found to have hypokalemia, and the commonness was higher than that in non-mentally sick subjects (67.7% versus 43.8%; individually, P = 0.002) (Figure 1). The most widely recognized clinical finding among restoratively treated suicide attempters was change issue (45.7%) trailed by incautious conduct (24.3%), real misery (10.7%), and nervousness (2.1%). Hypokalemia was essentially connected with the nearness of real gloom (P = 0.04), change issue (P < 0.001), tension (P = 0.01), and self-destructive endeavors (P = 0.04). In any case, normokalemia was fundamentally connected with incautious conduct (P < 0.001), the nonappearance of mental sickness (P = 0.002), and the nearness of incidental overdose (P = 0.04) (Table 1). One hundred and twelve patients with alteration issue and six patients with tension were found to have hypokalemia, and the pervasiveness of hypokalemia among these patients was higher than that in the general investigation populace and in patients with other mental clutters (100% and 87.5%, individually). Also, their mean potassium level was lower than that of the general examination populace (3.16 ± 0.41 and 3.2 ± 0.21 mmol/L, individually) (Table 2). Eight hypokalemic patients (4.5%) were enhanced with oral potassium medicine, and 85 hypokalemic patients (47.8%) were treated with intravenous potassium chloride, and their potassium levels were standardized in the following blood test. Moreover, the vast majority of the treated patients (59) were in mellow stage>