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Acetaminophen overdose

Última revisão: 15 Aug 2025
Última atualização: 07 Jan 2025

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

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

Fatores de risco

  • history of self-harm
  • history of frequent or repeated use of medications for pain relief
  • glutathione deficiency
  • increased cytochrome P450 activity
  • malnutrition or fasting
  • chronic ethanol consumption
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • serum acetaminophen level
  • serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT)
Detalhes completos

Investigações a serem consideradas

  • 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
Detalhes completos

Algoritmo de tratamento

AGUDA

acute single ingestion

repeated supratherapeutic acetaminophen ingestion

Colaboradores

Autores

Hannah Hays, MD, FACEP, FAACT, FACMT

Medical Director

Central Ohio Poison Center

Chief of Toxicology

Nationwide Children’s Hospital

Assistant Professor of Emergency Medicine and Pediatrics

The Ohio State University College of Medicine

Declarações

HH declares that she has no competing interests.

Agradecimentos

Dr. Hannah Hays would like to gratefully acknowledge Dr. Daniel K. Colby, Dr. Alastair Newton, and Professor Allan R. Mottram, previous contributors to this topic. DKC, AN, and ARM declare that they have no competing interests.

Revisores

Scott Phillips, MD

Clinical Faculty

Department of Toxicology

Rocky Mountain Poison & Drug Center

Denver

CO

Declarações

SP declares that he has no competing interests.

Gerald F. O'Malley, DO

Director

Division of Research

Department of Emergency Medicine

Albert Einstein Medical Center

Philadelphia

PA

Declarações

GFOM declares that he has no competing interests.

Sophie Gosselin, MD, FRCPC

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

Declarações

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.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Dart RC, Mullins ME, Matoushek T, et al. Management of acetaminophen poisoning in the US and Canada: a consensus statement. JAMA Netw Open. 2023 Aug 1;6(8):e2327739.Texto completo  Resumo

Fontana RJ, Liou I, Reuben A, et al. AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury. Hepatology. 2023 Mar 1;77(3):1036-65.Texto completo

Chiew AL, Gluud C, Brok J, et al. Interventions for paracetamol (acetaminophen) overdose. Cochrane Database Syst Rev. 2018 Feb 23;(2):CD003328.Texto completo  Resumo

American College of Medical Toxicology. ACMT Position statement: duration of intravenous acetylcysteine therapy following acetaminophen overdose. J Med Toxicol. 2017 Mar;13(1):126-7.Texto completo  Resumo

Artigos de referência

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