Highlights & Basics
- Acetaminophen overdose may occur after an acute single ingestion of a large amount of acetaminophen or acetaminophen-containing medication, or repeated ingestion of an amount exceeding recommended dosage.
- Though acetaminophen is generally safe when taken at recommended doses, overdose can lead to hepatotoxicity and hepatic failure. Acetaminophen is responsible for over half of all cases of acute liver failure in the US and is the second most common cause of liver transplant worldwide.
- Patients are often asymptomatic or have only mild gastrointestinal symptoms at initial presentation. Untreated acetaminophen poisoning may cause varying degrees of liver injury over the 1 to 4 days following ingestion, including fulminant hepatic failure.
- Rarely, massive overdose may initially present with coma and severe metabolic acidosis. Presentation with coma may also occur if a combination preparation of acetaminophen and opioid is taken in overdose, or after an overdose of multiple drugs.
- Hepatotoxicity is extremely rare in patients treated with acetylcysteine within 8 hours of an acute acetaminophen overdose. The efficacy of acetylcysteine decreases subsequent to the first 8 hours following an acute acetaminophen overdose, with a corresponding stepwise increase in hepatotoxicity with increasing treatment delays beyond 8 hours.
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Citations
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American College of Medical Toxicology. ACMT Position statement: duration of intravenous acetylcysteine therapy following acetaminophen overdose. J Med Toxicol. 2017 Mar;13(1):126-7.[Abstract][Full Text]
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