I'm not disagreeing with you or trying to be disagreeable, but how do people accidentally exceed 3-4 grams daily? That's 6-8 pills!

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).

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.

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.

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?"

Hot Coldrex (Tylenol) + Pills. People don't read.

My mother in law did this. There are a lot of ignorant and uneducated people out there. They think "take this for pain" = "take more for more pain", popping one an hour not really understanding how insanely dangerous it is since acetaminophen has such a subtle effect until it's too late.

It's in all kinds of medicine. People take some pills and then add a cough syrup, not noticing that the syrup also contains it as an active ingredient.

If you're taking a lot of pills, which ill people often do (e.g., cancer patients), it's easy to forget.

Also, people with memory issues...

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.