The diagnosis of potential acetaminophen toxicity is based on obtaining a history of acetaminophen ingestion and the measurement of a potentially toxic serum APAP concentration. Acetaminophen ingestion should be considered as a potential cause of illness in patients who present with hepatic dysfunction of unknown etiology.
When evaluating a patient with suspected acetaminophen toxicity, also consider other conditions that can cause acute hepatotoxicity or have a similar clinical presentation. The following conditions should be considered as part of the possible differential diagnosis:
Drug-induced or toxin-induced hepatitis
Inborn errors of metabolism, including alpha1-antitrypsin (AAT) deficiency or fatty acid oxidation abnormalities
Viral hepatitis due to Epstein-Barr virus or varicella
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