![]() (A false-positive acetaminophen level may be found in the setting of severe hyperbilirubinemia, > 10 mg/mL, from another cause.) In the case of a single ingestion at a known time, serum acetaminophen level at 4-24 hours post-ingestion can be used to predict the risk of hepatotoxicity using the Rumack-Matthew nomogram (see Figure below). Chronic liver disease is not associated with increased risk. 2įactors that may slightly increase susceptibility to acetaminophen-related hepatotoxicity include age > 40 years, tobacco use, malnutrition or starvation, and anything else that may impact the way acetaminophen is metabolized in the liver: presence of certain polymorphisms of cytochrome isoenzymes, chronic alcohol ingestion, or chronic use of medications that induce P450 isoenzymes such as some anticonvulsants and isoniazid. Histologically, normal liver architecture is restored within about 3 months from initial ingestion/overdose. Of those who develop acute liver failure, 70% survive and recover fully with supportive care. ![]() 3,4 (Interestingly, of those cases with acute liver failure from acetaminophen, half or more are unintentional overdoses.) Fortunately, with current treatment more than 90% of patients with acetaminophen toxicity recover completely. 2 It is the most common cause of acute liver failure in many Western countries, accounting for 40%-50% of cases in the United States. 1 Acetaminophen overdose may lead to hepatotoxicity, acute tubular necrosis and, less likely, pancreatitis. In 2008, however, according to the American Association of Poison Control Centers, acetaminophen overdose occurred in 27,790 cases, resulting in 13,650 hospitalizations and 43 deaths. Pierson and Thompson report no financial relationships relevant to this field of study.Īcetaminophen (known as paracetamol outside the United States) is the most commonly used analgesic in the world, usually considered to be safe and benign. Thompson is Associate Professor of Medicine, University of Washington. Pierson is Professor, Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, and Dr. ![]() Pierson, MD, and peer reviewed by William Thompson, MD. This article originally appeared in the December issue of Critical Care Alert. Akhtar reports no financial relationship to this field of study. Luke's Idaho Pulmonary Associates, Boise.
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