Table of contents
Expand All Topics
Acetaminophen overdose
Background
Overview
Definition
Acetaminophen overdose is defined as the ingestion of a dose of acetaminophen that exceeds the recommended limit, typically > 4 g within a 24-hour period or excessive doses over several days.
1
Pathophysiology
The pathophysiology of acetaminophen overdose involves its action as a dose-dependent hepatotoxin, causing acute pericentral liver injury. Acetaminophen is metabolized in the liver, and in overdose situations, its toxic metabolite can cause hepatocellular necrosis. In some cases, renal insufficiency can also occur, attributed to cytochrome P-450 mixed function oxidase isoenzymes present in the kidney.
2
3
Epidemiology
In 2021, US poison control centers recorded over 80,000 cases related to acetaminophen products. The incidence of acetaminophen overdose in Iceland is estimated at 16 per 100,000 person-years.
2
4
Disease course
Clinical manifestations of acetaminophen overdose can include symptoms such as nausea, vomiting, abdominal pain, and in severe cases, mental status changes. Hepatotoxicity is indicated by elevated liver enzymes, and in severe cases, it can lead to ALF, characterized by encephalopathy and coagulopathy.
1
5
Prognosis and risk of recurrence
The severity of liver damage, as indicated by laboratory tests such as serum transaminases and coagulation profile, is a key determinant of prognosis. The prognosis in acetaminophen-related ALF is related to the degree of encephalopathy, coagulopathy, and acidosis.
1
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of acetaminophen overdose are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2024), the American College of Gastroenterology (ACG 2023), the American Association for the Study of Liver Diseases (AASLD 2022), the Treatment of Paracetamol Poisoning Writing Group (TPPWG 2020), the Extracorporeal Treatments ...
Show more