Acetaminophen Toxicity Questions & Answers

Updated: Jan 17, 2020
  • Author: Susan E Farrell, MD; Chief Editor: Michael A Miller, MD  more...
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Questions & Answers

Overview

What is acetaminophen and what are the risks for toxicity/poisoning?

What are the initial symptoms of acetaminophen toxicity/poisoning?

What are minimum toxic doses of acetaminophen?

What is the clinical course of acetaminophen toxicity/poisoning?

What is the basis for diagnosis and treatment of acetaminophen toxicity/poisoning?

What are the recommended serum studies in the workup of acetaminophen toxicity/poisoning?

Which tests are indicated in patients with mental status changes due to acetaminophen toxicity/poisoning, and what lab findings are associated with hepatotoxicity?

How is the Rumack-Matthew nomogram used in the workup of acetaminophen toxicity/poisoning?

How is acetaminophen toxicity/poisoning managed?

What is the role of N -acetylcysteine (NAC) in the treatment of acetaminophen toxicity/poisoning?

What is the dosage regimen of N -acetylcysteine (NAC) for the treatment of acetaminophen toxicity/poisoning?

When is the IV formulation of N -acetylcysteine (NAC) preferred in the treatment of acetaminophen toxicity/poisoning?

When is surgical evaluation indicated in acetaminophen toxicity/poisoning and what are the criteria for liver transplantation?

How commonly is acetaminophen used?

What is acetaminophen used for and what formulations are available?

How often does acetaminophen toxicity/poisoning occur?

At what age can acetaminophen toxicity/poisoning occur?

What is the FDA doing to reduce the incidence of acetaminophen toxicity/poisoning in the US?

What is the workup and treatment approach for IV acetaminophen toxicity/poisoning?

When is end-organ toxicity caused by acetaminophen poisoning clinically evident?

How effective is oral activated charcoal for the treatment of acetaminophen toxicity/poisoning?

What is the pathophysiology of acetaminophen toxicity/poisoning?

What is the role of N-acetyl-p -benzoquinoneimine (NAPQI) in the pathophysiology of acetaminophen toxicity/poisoning?

What are the maximum recommended daily doses and minimum hepatotoxic dose of N-acetyl-p-aminophenol (APAP) in acetaminophen toxicity/poisoning?

What is the mechanism of action of N -acetylcysteine (NAC) in the treatment of acetaminophen toxicity/poisoning?

When is N -acetylcysteine (NAC) administered for the treatment of acetaminophen toxicity/poisoning?

Which factors enhance susceptibility to acetaminophen toxicity/poisoning?

Which medications and agents increase the risk of acetaminophen toxicity/poisoning?

What are the recommended maximum daily dosages of acetaminophen in adults and children?

What are the minimum toxic acetaminophen dosages in adults and children?

What acetaminophen dosages are considered toxic in adults and children?

What FDA recommendations are aimed at reducing the incidence of acetaminophen–induced hepatotoxicity?

How does chronic acetaminophen toxicity/poisoning occur in children?

What are the risk factors for chronic acetaminophen toxicity/poisoning?

What is the incidence of acetaminophen toxicity/poisoning in the US and what is the mortality?

What is the role of acetaminophen toxicity/poisoning in liver transplantation?

What is the mortality rate of acetaminophen toxicity/poisoning?

What increases the risk of morbidity associated with acetaminophen toxicity/poisoning?

What is the prognosis of pediatric patients with acute acetaminophen toxicity/poisoning?

What are the prognostic indicators in acetaminophen toxicity/poisoning?

How should patients be educated about acetaminophen use?

How should parents and caregivers be educated about acetaminophen use in children?

Presentation

When does clinical evidence of end-organ toxicity associated with acetaminophen poisoning manifest?

What are the phases of the clinical course of acetaminophen toxicity/poisoning?

What is phase 1 of acetaminophen toxicity/poisoning?

What is phase 2 of acetaminophen toxicity/poisoning?

What is phase 3 of acetaminophen toxicity/poisoning?

What is phase 4 of acetaminophen toxicity poisoning?

DDX

How is acetaminophen toxicity/poisoning diagnosed?

Which conditions should be considered in the DDX of acetaminophen toxicity/poisoning?

What are the differential diagnoses for Acetaminophen Toxicity?

Workup

Which lab study is the basis for the diagnosis and treatment of acetaminophen toxicity/poisoning?

How is the Rumack-Matthew nomogram used in the workup of acetaminophen toxicity/poisoning?

How are ECG and a serum salicylate level used in the workup of acetaminophen toxicity/poisoning?

What is the role of liver function tests (LFTs) in the workup of acetaminophen toxicity/poisoning)?

How are prothrombin time (PT) and international normalized ratio (INR) studies used in the workup of acetaminophen toxicity/poisoning?

What is the role of a serum glucose concentration study in the workup of acetaminophen toxicity/poisoning?

How are renal function tests used in the workup of acetaminophen toxicity/poisoning?

What is the role of a lipase concentration in the workup of acetaminophen toxicity/poisoning?

What is the role of abdominal ultrasonography in the workup of acetaminophen toxicity/poisoning?

When is a pregnancy test indicated in the workup of acetaminophen toxicity/poisoning?

What is the role of serum phosphate values in the workup of acetaminophen toxicity/poisoning?

Which lab studies are indicated in altered mental status associated with acetaminophen toxicity/poisoning?

When is brain CT scanning indicated in the workup of acetaminophen toxicity/poisoning?

What are key lab findings during the first 3 phases of hepatotoxicity in acetaminophen toxicity/poisoning?

How is the Rumack-Matthew nomogram used in the workup of acetaminophen toxicity/poisoning and what information does it provide?

When is the Rumack-Matthew nomogram contraindicated in the workup of acetaminophen toxicity/poisoning?

What is the role of an anion gap value in the workup of acetaminophen toxicity/poisoning?

How are N -acetyl-p -benzoquinoneimine (NAPQI)-protein adducts used in the workup of acetaminophen toxicity/poisoning)?

What are the histologic features of hepatotoxicity associated with acetaminophen poisoning?

Treatment

What is for the role of supportive care in the treatment of acetaminophen toxicity/poisoning?

What is the protocol for emergency department treatment of acetaminophen toxicity/poisoning?

How is N -acetylcysteine (NAC) used in the treatment of acetaminophen toxicity/poisoning?

When is surgical evaluation indicated in the treatment of acetaminophen toxicity/poisoning and what are the criteria for liver transplantation?

When is oral activated charcoal (AC) administered in the treatment of acetaminophen toxicity/poisoning?

How effective is oral activated charcoal (AC) in the treatment of acetaminophen toxicity/poisoning?

What is the drug of choice for the treatment of acetaminophen toxicity/poisoning and what is the recommended regimen?

What is the safety and efficacy of N -acetylcysteine (NAC) for the treatment of acetaminophen toxicity/poisoning?

When is IV N -acetylcysteine (NAC) indicated for the treatment of acetaminophen toxicity/poisoning?

What are the recommended dosages of IV N -acetylcysteine (NAC) for the treatment of acetaminophen toxicity/poisoning?

How are administration errors with IV N -acetylcysteine (NAC) for the treatment of acetaminophen toxicity minimized?

When is intermittent IV N -acetylcysteine (NAC) indicated in the treatment of acetaminophen toxicity/poisoning?

What are the adverse effects of IV N -acetylcysteine (NAC) in the treatment of acetaminophen toxicity/poisoning and how are they addressed?

How are N -acetylcysteine (NAC) and oral activated charcoal used together to treat acetaminophen toxicity/poisoning?

How are multidrug ingestions addressed with N -acetylcysteine (NAC) and activated charcoal (AC) in the treatment of acetaminophen toxicity/poisoning?

What treatment is indicated in a delayed presentation of acetaminophen toxicity/poisoning?

What are the benefits of N -acetylcysteine (NAC) in the treatment of hepatic failure associated with acetaminophen toxicity/poisoning?

When is N -acetylcysteine (NAC) indicated in the treatment of delayed presentations of acetaminophen-induced hepatic failure?

Why is N -acetylcysteine (NAC) beneficial in late presentations of acetaminophen toxicity/poisoning?

Which factors determine how long N -acetylcysteine (NAC) therapy is indicated for the treatment late presentations of acetaminophen toxicity/poisoning?

What is the treatment for acetaminophen toxicity/poisoning due to chronic supratherapeutic use?

What are the treatment considerations in extended-release acetaminophen toxicity/poisoning?

What is the recommended management of extended-release acetaminophen toxicity/poisoning?

Which consultations are indicated in acetaminophen toxicity/poisoning?

Medications

Which medications are used in the treatment of acetaminophen toxicity/poisoning?

Which medications in the drug class Antiemetics are used in the treatment of Acetaminophen Toxicity?

Which medications in the drug class Antidotes, Other are used in the treatment of Acetaminophen Toxicity?