acetaminophen poisoning

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acetaminophen poisoning

Poisoning resulting from an overdose of acetaminophen, causing injury to or necrosis of the liver, or liver failure. Because acetaminophen is one of the most commonly used over-the-counter pain relievers and prescription drugs, this is one of the most common poisonings encountered in emergency departments and hospitals. If a reliable history of the amount of drug can be obtained, ingestions that exceed 7.5 g in the adult or about 150 mg/kg in children should always be considered potentially toxic. In most cases, data about overdoses are not reliable, and plasma levels of acetaminophen concentration are routinely measured and compared with standard nomograms to decide whether a patient will need antidotal therapy with N-acetylcysteine.

Clinical Course

Shortly after ingestion, patients may suffer nausea, vomiting, and malaise. If appropriate treatment is not instituted, hepatitis develops, with elevated liver enzymes in the first day, and jaundice and coagulation disorders by about 36 hr. Encephalopathy may follow. A prolonged course of recovery or complete liver failure may result, depending on the amount of drug ingested and the severity of the liver injury.

Patient care

Gastrointestinal (GI) decontamination with activated charcoal absorbs toxin from the GI tract, but it should be given within 4 hr of ingestion of the drug. A specific antidote, N-acetylcysteine, is given orally within 8 to 10 hr after ingestion in an initial dose of 140 mg/kg and then in 70 mg/kg doses every 4 hr for 17 doses if acetaminophen levels are toxic. Alternatively, acetylcysteine may be administered intravenously. Blood should be drawn for stat acetaminophen level, complete blood count, electrolyte levels, blood urea nitrogen, serum creatinine, serum glucose, liver function, prothrombin time, and further toxicology screens. Urine should also be analyzed for drug content. If the patient with a suspected overdose is a female of child-bearing age, a pregnancy test should be done as a part of routine laboratory studies. The overdosed patient should be cared for in an intensive care unit until medically and psychiatrically cleared for discharge. ; Rumack nomogram


Taking more than 4 g of acetaminophen in one day (adults) or more than 90 mg/kg (children) can damage the liver and may lead to coma, kidney failure, and death.
See also: poisoning
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References in periodicals archive ?
N-acetylcysteine overdose after acetaminophen poisoning. Int Med Case Rep J.
Predictors of outcome after acetaminophen poisoning in children and adolescents.
Ingestion of higher doses, however, can lead to acetaminophen poisoning with hepatotoxicity (10-15 g/day) and maybe fatal (20-25 g/day).Weestimated that this patient ingested approximately 15 g acetaminophen and thus was at risk for fulminant hepatic failure.
Patients with acetaminophen poisoning can have transaminase levels over 3,500 U/L.
About 100 people die annually of accidental acetaminophen poisoning, and another 15,000 are seen in hospital emergency rooms as a result of unknowingly taking too much.
They found a similar situation with acetaminophen poisoning. Having a pregnant mother or a new sibling doubles the chances the child will take a serious dose of this drug.
Mechanism of action and value of N-acetylcysteine in the treatment of early and late acetaminophen poisoning: A critical review.
Kawamura, a former painter who was hospitalized May 30 last year for liver disease apparently caused by acetaminophen poisoning, had a life insurance policy worth about 1.14 billion yen.
Hepatotoxicity from acetaminophen poisoning is a serious medical problem
The FDA reports that at least 33 American children below age 13 have died of acetaminophen poisoning from 1970 to 1991; 152 others suffered serious consequences that required hospitalization and, sometimes, produced permanent disability.
Acetaminophen poisoning: anevidence-based consensus guideline for out-of-hospital management.