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Acetaminophen ToxicityAka: Acetaminophen Overdose

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  1. Risk Factors: Serious to lethal hepatotoxicity
    1. Acetaminophen Overdosage
      1. Adults: 7.5 grams in 24 hours (or 150-250 mg/kg)
    2. Concurrent interacting factors: Lowers the threshold for N-Acetylcysteine use
      1. Dehydration, fasting or malnutrition
      2. Alcohol Abuse
      3. Cirrhosis
      4. Concurrent use of other medications
        1. Isoniazid (reports of hepatotoxicity with concurrent Acetaminophen 3.2 grams)
        2. Zidovudine
        3. Barbiturate
        4. Phenytoin
        5. Acarbose
  2. Stages
    1. Stage 1 (0-24 hours): Asymptomatic with normal Liver Function Tests
    2. Stage 2 (24-48 hours): Liver Function Tests begin to rise
    3. Stage 3 (48-72 hours): Liver Function Tests peak, and symptoms and signs evident
      1. Jaundice
      2. Metabolic Acidosis
      3. Acute Renal Failure
    4. Stage 4 (>72 hours): Fulminant liver failure and death or Survival
  3. Labs
    1. Acetaminophen Level
      1. First level at 4 hours: >150 indicates treatment as below
        1. Concurrent interacting factors above lower the threshold for treatment
      2. Consider obtaining at 2 hours: <50 is reassuring
    2. Liver Function Tests
  4. Management: N-Acetylcysteine (NAC)
    1. Indications
      1. See Acetaminophen level as above
    2. Preparations
      1. Mucomyst oral or nebulized
      2. Acetadote intravenous
    3. Dosing: Adults
      1. First dose: NAC 140 mg/kg up to 14 grams
      2. Subsequent doses: NAC 70 mg/kg up to 7 grams every 4 hours
    4. Duration
      1. Standard Course is 72 hours
      2. Abbreviated course of 24 hours and until Acetaminophen level <10
        1. Appears safe and effective

Poisoning by acetaminophen (C0237963)

ConceptsInjury or Poisoning (T037)
ICD9965.4
EnglishAcetaminophen poisoning, ACETAMINOPHEN TOXICITY, Paracetamol poisoning, Poisoning by acetaminophen, Poisoning by paracetamol, TYLENOL TOXICITY
Spanishintoxicación por acetaminofeno, intoxicación por paracetamol, intoxicacion por acetaminofeno, intoxicacion por paracetamol
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Acetaminophen overdose (C0572025)

ConceptsInjury or Poisoning (T037)
EnglishAcetaminophen overdose, Paracetamol overdose
Spanishsobredosis de paracetamol
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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