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Acetaminophen Poisoning


Gerald F. O’Malley

, DO, Grand Strand Regional Medical Center;

Rika O’Malley

, MD, Grand Strand Medical Center

Reviewed/Revised May 2022 | Modified Sep 2022

Acetaminophen, a common ingredient in many prescription and non-prescription drugs, is safe in normal doses, but severe overdose can cause liver failure and death.

  • People sometimes ingest too many products that contain acetaminophen and poison themselves.

  • Depending on the amount of acetaminophen in the blood, symptoms range from none at all to vomiting and abdominal pain to liver failure and death.

  • The diagnosis is based on the amount of acetaminophen in the blood and results of liver function tests.

  • Acetylcysteine is given to reduce the toxicity of the acetaminophen.

More than 100 products contain acetaminophen, a common over-the-counter pain reliever that is also present in many combination prescription drugs. If several similar products are consumed at a time, a person may inadvertently take too much acetaminophen. Many preparations intended for use in children are available in liquid, tablet, and capsule form, and a parent may try several preparations simultaneously or within several hours to treat a fever or pain, not realizing they all contain acetaminophen.

Acetaminophen usually is a very safe drug, but it is not harmless. To cause poisoning, several times the recommended dose of acetaminophen must be taken. For example, the recommended dose for a person who weighs 155 pounds (70 kg) is two to three 325-milligram tablets every 6 hours. A toxic dose for this person is at least about thirty tablets taken all at once. Death is extremely unlikely unless the person takes more than forty 325-milligram tablets. Therefore, a single acetaminophen overdose that causes serious toxicity is usually not accidental.

Symptoms of Acetaminophen Poisoning

Most overdoses cause no immediate symptoms. If the overdose is very large, symptoms develop in 4 stages:

If toxicity results from multiple smaller doses taken over time, the first indication of the problem may be abnormal liver function, sometimes with jaundice and/or bleeding.

Diagnosis of Acetaminophen Poisoning

  • Acetaminophen levels in the blood

  • Abnormal liver function tests

The doctor considers acetaminophen poisoning in people who may be attempting suicide Suicidal Behavior Suicide is death caused by an act of self-harm that is intended to be lethal. Suicidal behavior includes completed suicide, attempted suicide, and suicidal ideation (thoughts and ideas). Suicide... read more , in children who were given cough and cold preparations containing acetaminophen, and in people who may have accidentally ingested acetaminophen.

Doctors can predict the likelihood of acetaminophen toxicity by the amount ingested or, more accurately, by the level of acetaminophen in the person's blood. The blood level, measured between 4 hours and 24 hours after ingestion, may help predict the severity of the liver damage. Blood tests of liver function can sometimes help, particularly if toxicity may have resulted from doses repeated over time.

Treatment of Acetaminophen Poisoning

  • Charcoal and/or acetylcysteine

  • Sometimes, treatment for liver failure or liver transplant

If acetaminophen was taken within the previous several hours, activated charcoal may be given.

If the level of acetaminophen in the blood is high, the drug acetylcysteine is generally given by mouth or by vein to reduce the toxicity of the acetaminophen. Acetylcysteine is given repeatedly, for one to several days. This antidote helps prevent liver injury but does not reverse injury that has already occurred. Therefore, acetylcysteine must be given before liver injury occurs. Treatment for liver failure Treatment Liver failure is severe deterioration in liver function. Liver failure is caused by a disorder or substance that damages the liver. Most people have jaundice (yellow skin and eyes), feel tired... read more or liver transplant Liver Transplantation Liver transplantation is the surgical removal of a healthy liver or sometimes a part of a liver from a living person and then its transfer into a person whose liver no longer functions. (See... read more may also be necessary.

If toxicity results from multiple smaller doses taken over time, predicting the course of liver injury is difficult. Acetylcysteine is given if tests indicate liver damage is possible and sometimes if liver damage has already developed.

More Information

The following is an English-language resource that may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

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