Acetaminophen Poisoning: Diagnosis and Treatment

Course overview

Acetaminophen poisoning is the most common cause of acute liver failure in the United States and other countries. Acetaminophen overdose can cause renal and other organ system damage, although this is rare. After a chronic overdose, the toxic dose of acetaminophen depends on how long the patient has been taking the drug and the presence of risk factors. Use of the Rumack-Matthew nomogram helps to determine whether an acute acetaminophen ingestion can be expected to be toxic or non-toxic. In chronic acetaminophen use, a serum level should be measured to determine the need for treatment. The standard treatment for acetaminophen overdose is activated charcoal, and N-acetylcysteine if the clinician determines N-acetylcysteine is needed. Other antidotal therapies may also be considered. If a patient is treated appropriately and promptly, the prognosis is typically good. In some cases, liver transplantation is needed.