Not enough relief from too much acetaminophen

Abstract

In this issue of Annals, Daly et al discuss their experiences with the supratherapeutic use of acetaminophen. Their descriptive data highlight important information physicians should keep in mind when evaluating patients who present with a known or suspected history of excessive acetaminophen use. This prospective, poison center–based study enrolled 249 patients, aged 12 years or older, whose emergency department (ED) presentation involved the repeated supratherapeutic ingestion of an acetaminophencontaining product and initiated a referral to a poison center. In this study, repeated supratherapeutic ingestion was defined as ‘‘more than 1 ingestion of acetaminophen during a period exceeding 8 hours that resulted in a cumulative dose of greater than 4.0 g per 24 hours.’’ Patients were stratified on the basis of their presenting aspartate aminotransferase level, with less than 50 IU/L defined as normal and greater than 1,000 IU/L defined as manifesting hepatotoxic. The authors conclude that injury from supratherapeutic acetaminophen ingestion was apparent at presentation and related to dose magnitude and duration. They suggest that an abnormal aspartate aminotransferase level at presentation may represent an indicator of developing hepatotoxicity, and a normal aspartate aminotransferase level at presentation accompanied by a serum acetaminophen concentration less than 10 mg/L may allow early discharge from the ED.