Acetaminophen toxicity: A continuing challenge

Introduction: Acetaminophen is increasingly involved in accidental and intentional poisoning contributing to significant morbidity, intensive care unit admissions and cost of hospitalization. We determined the prevalence and characteristics of acetaminophen associated hepatotoxicity. Methods: We reviewed the medical records of 93 consecutive patients hospitalized for acetaminophen toxicity. Results: Acetaminophen accounted for 7.5% of all cases of poisoning admitted during this period. Female to male ratio was 2:1 with a predominance of whites (69%). Table 1 Conclusion: Acetaminophen poisoning has remained a significant reason for hospital admission among young adults. Patients who were hospitalized for acetaminophen toxicity related to accidental misuse had higher rates of morbidity and mortality than those who attempted suicide although the latter had higher median acetaminophen levels. A higher frequency of chronic alcohol abuse among the patients with accidental overdose may be one explanation. The peak acetaminophen levels usually decide admission to critical care areas, which correlate poorly with hepatic dysfunction, morbidity and mortality. We recommend that the patients with suicidal acetaminophen overdose because of their benign clinical course can be safely managed on the medical floors unless there is a history of concomitant alcohol ingestion. In our hospital this would translate into a cost saving of $500,000 per year. Table 1 Variable Suicidal, n=80 Accidental, n=13 p value Peak acetaminophen level mg/lit(Median) 99 49 <0.05 Peak aminotraniferase>1000 IU/lit 10/80 (12%) 5/13 (39%) <0.05 Chronic alcohol Intake 15/80 (18%) 5/13 (39%) =0.05 Hepatic coma 0/80 (0%) 2/13 (15%) <0.05 Deaths 0/80 (0%) 2/13 (15%) <0.05.