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Acetaminophen Poisoning

Luis T. Garcia, MD and Kenneth Polezoes, MD Reviewed 06/2019
 


BASICS

DESCRIPTION

  • A disorder characterized by hepatic necrosis following large ingestions of acetaminophen. Although patients can be asymptomatic, common presenting symptoms include nausea, vomiting, ...

DIAGNOSIS

  • May initially be asymptomatic, particularly with history of ingestion in preceding 8 hours. Signs and symptoms of poisoning are related to liver toxicity and develop over the first 24 hours ...

TREATMENT

  • Contact a regional/local poison control center for recommendations. In the United States: (800) 222-1222

  • Give NAC when plasma acetaminophen concentrations measured ≥4 hours after ingestion ar...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Evaluate all patients at a health care facility.

  • Evaluate patients with evidence of organ failure, increased LFTs, or coagulopathy for emergency liver transplant (...

REFERENCES

1
Chiew AL, Gluud C, Brok J, et al. Interventions for paracetamol (acetaminophen) overdose. Cochrane Database Syst Rev.  2018;(2):CD003328. [View Abstract on OvidMedline]
2
Spiller HA, Wi...

ADDITIONAL READING

  • Major JM, Zhou EH, Wong HL, et al. Trends in rates of acetaminophen-related adverse events in the United States. Pharmacoepidemiol Drug Saf.  2016;25(5):590–598. [View Abstract...

CODES

ICD10

  • T39.1X4A Poisoning by 4-Aminophenol derivatives, undetermined, init

  • K71.10 Toxic liver disease with hepatic necrosis, without coma

  • T39.1X1A Poisoning by 4-Aminophenol derivatives, accidental,...

CLINICAL PEARLS

  • Consult with Poison Control center for management recommendations (800) 222-1222 in United States.

  • Give NAC when plasma acetaminophen concentrations (measured ≥4 hours after ingestion) ...

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