Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • attempted self-harm
  • repeated over-the-counter analgesic use for pain relief
  • asymptomatic presentation
  • nausea, vomiting, or abdominal pain
  • RUQ pain and tenderness
  • jaundice
  • confusion, decreased consciousness level, and/or asterixis

Risk factors

  • hx of self-harm
  • hx of frequent or repeated use of medications for pain relief
  • glutathione deficiency
  • drugs that induce liver enzymes (CYP 450 inductors)

Diagnostic investigations

1st investigations to order

  • serum acetaminophen level
  • serum AST and ALT
Full details

Investigations to consider

  • arterial pH and lactate level
  • metabolic panel or serum electrolytes with BUN and creatinine
  • serum prothrombin time and INR
  • serum salicylate level
  • ethanol level
  • blood glucose level
  • lipase level
  • serum phosphate
  • alpha-fetoprotein
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Associate Professor of Emergency Medicine

University of Colorado School of Medicine

Aurora

CO

Disclosures

The employer of KH received research grants from McNeil Consumer Healthcare, a manufacturer of acetaminophen.

Staff Specialist in Emergency Medicine

Emergency Department

The Prince Charles Hospital

Brisbane

Queensland

Australia

Disclosures

AN declares that he has no competing interests.

Professor Kennon Heard and Dr Alastair Newton would like to gratefully acknowledge Professor Allan R. Mottram, a previous contributor to this topic.

Disclosures

ARM declares that he has no competing interests.

Peer reviewers VIEW ALL

Clinical Faculty

Department of Toxicology

Rocky Mountain Poison & Drug Center

Denver

CO

Disclosures

SP declares that he has no competing interests.

Director

Division of Research

Department of Emergency Medicine

Albert Einstein Medical Center

Philadelphia

PA

Disclosures

GFOM declares that he has no competing interests.

Associate Professor

Department of Medicine

McGill University

Emergency Physician and Medical Toxicologist

McGill University Health Centre

Medical Toxicologist

Centre Antipoison du Québec

Montreal

Quebec

Canada

Disclosures

SG declares that she is an unpaid co-investigator in the Canadian Acetaminophen Overdose Study and unpaid co-chair of the Extracorporeal Treatment In Poisoning workgroup.

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