Acetaminophen Toxicity Differential Diagnoses

Updated: Oct 05, 2021
  • Author: Susan E Farrell, MD; Chief Editor: Michael A Miller, MD  more...
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Diagnostic Considerations

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
  • Hepatobiliary disease
  • Hepatorenal syndrome
  • Inborn errors of metabolism, including alpha1-antitrypsin (AAT) deficiency or fatty acid oxidation abnormalities
  • Reye syndrome
  • Viral hepatitis due to Epstein-Barr virus or varicella

Differential Diagnoses