Acetaminophen Poisoning

Angela L Chiew; Nicholas A Buckley

doi:10.1016/j.ccc.2021.03.005

Acetaminophen Poisoning

Crit Care Clin. 2021 Jul;37(3):543-561. doi: 10.1016/j.ccc.2021.03.005.

Authors

Angela L Chiew¹, Nicholas A Buckley²

Affiliations

¹ Clinical Toxicology Unit, Prince of Wales Hospital, Barker Street, Randwick, New South Wales 2031, Australia. Electronic address: angela.chiew@health.nsw.gov.au.
² Pharmacology and Biomedical Informatics and Digital Health, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales 2050, Australia.

PMID: 34053705
DOI: 10.1016/j.ccc.2021.03.005

Abstract

Acetaminophen is a common medication taken in deliberate self-poisoning and unintentional overdose. It is the commonest cause of severe acute liver injury in Western countries. The optimal management of most acetaminophen poisonings is usually straightforward. Patients who present early should be offered activated charcoal and those at risk of acute liver injury should receive acetylcysteine. This approach ensures survival in most. The acetaminophen nomogram is used to assess the need for treatment in acute immediate-release overdoses with a known time of ingestion. However, scenarios that require different management pathways include modified-release, large/massive, and repeated supratherapeutic ingestions.

Keywords: Acetaminophen; Acetylcysteine; Acute liver injury; Hepatotoxicity; Poisoning.

Publication types

Review

MeSH terms

Acetaminophen
Acetylcysteine / therapeutic use
Analgesics, Non-Narcotic* / therapeutic use
Chemical and Drug Induced Liver Injury* / etiology
Chemical and Drug Induced Liver Injury* / therapy
Drug Overdose* / therapy
Humans

Substances

Analgesics, Non-Narcotic
Acetaminophen
Acetylcysteine