Acetaminophen poisoning: an update for the intensivist.
Acetaminophen overdose is common and can result from deliberate/nonstaggered or accidental/staggered ingestion. Patients presenting within 24 h of an acetaminophen overdose can safely be managed on medical wards. Early management of nonstaggered overdose is guided by the plasma acetaminophen concentration, whereas management of accidental/staggered ingestion is guided by ingested dose. Ingested dose and time from ingestion to presentation are important prognostic factors in accidental/staggered ingestion. Acetaminophen-induced acute liver failure (ALF) requires meticulous supportive care in an intensive care unit (ICU), with early identification and transfer of patients who are likely to require liver transplantation to a specialist liver centre. The modified King's College Hospital criteria (incorporating lactate into the traditional criteria) represent the best tool for identifying patients who require transplantation.
Dargan
Paul I
PI
Specialist Registrar in Medicine and Clinical Toxicology, National Poisons Information Service, Guy's & St Thomas' NHS Trust, London, UK. paul.dargan@gstt.sthames.nhs.uk
Jones
Alison L
AL
D000082:Acetaminophen / Q000097:blood / Q000506:poisoning*; D000111:Acetylcysteine / Q000627:therapeutic use*; D018712:Analgesics, Non-Narcotic / Q000097:blood / Q000506:poisoning*; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology* / Q000601:surgery; D003422:Critical Care; D006801:Humans; D016031:Liver Transplantation; D011379:Prognosis
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen; D000111:Acetylcysteine