title: Toxicity of acetaminophen overdose.
abstract: Symptoms of toxicity following overdose of acetaminophen (APAP), now a common household medication, occur 24 to 48 hours following ingestion. Toxicity is mainly to the liver but, while data has implicated a minor metabolite, the precise mechanism is not known. Toxicity is likely to occur after a minimum ingestion of 140 mg/kg, but the toxic dose may vary as a function of individual glutathione levels. Since the early clinical picture is not diagnostic, APAP plasma levels must be measured. Supportive care alone has resulted in a 5% to 10% mortality with a high incidence of hepatic toxicity. Treatment within 10 to 12 hours following ingestion with any therapeutic agent reduced mortality to zero and diminished liver toxicity. N-acetylcysteine is an investigational new drug for treating APAP toxicity and can ethically be used if the patient is first enrolled in the current nationwide evaluation. Recommended treatment steps in a suspected APAP poisoning are 1) emesis or lavage; 2) plasma APAP determination; 3) obtain treatment protocol from the Rocky Mountain Poison Center; 4) history of use of other pharmacologic agents, and 5) diuresis, alkalinization or hemodialysis, as in aspirin poisoning, are contraindicated.
mesh_terms: D000082:Acetaminophen / Q000378:metabolism / Q000506:poisoning* / Q000627:therapeutic use; D000111:Acetylcysteine / Q000627:therapeutic use; D003543:Cysteamine / Q000627:therapeutic use; D006801:Humans; D008715:Methionine / Q000627:therapeutic use
chemical_list: D000082:Acetaminophen; D003543:Cysteamine; D008715:Methionine; D000111:Acetylcysteine