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Accidental Overdoses of Acetaminophen in Alcohol Users

The overall incidence and clinical profile of acetaminophen toxicity have not been well described. These authors performed a retrospective chart analysis of patients admitted to an urban county hospital over a 40-month period, and identified 71 with hepatic necrosis or an acetaminophen level greater than 10 mg/l.

Of the 71 patients, 50 had attempted suicide by overdose, and 21 had accidental toxic effects while taking acetaminophen doses that were generally only slightly higher than recommended. The accidental-overdose group had a higher rate of chronic alcohol abuse than the suicidal group (63% vs. 25%) and a higher rate of liver damage -- despite taking only half as much acetaminophen as the suicidal group. Four patients with accidental overdose and one of those with suicidal ingestion died. Acetaminophen toxicity, mostly by accidental overdose, was the most common cause of acute liver failure at this hospital.

Comment: Acetaminophen is the most commonly used pain reliever in the U.S. Although it has a wide margin of safety, this report is the first to identify the significantly narrowed gap between therapeutic and toxic doses in specific risk groups. Acetaminophen should be taken cautiously, especially by patients who drink alcohol or who fast. However, we should continue to recognize its favorable safety profile for the vast majority of patients.

— JG Adams

Published in Journal Watch Emergency Medicine January 1, 1998

Citation(s):

Schiodt FV et al. Acetaminophen toxicity in an urban county hospital. N Engl J Med 1997 Oct 16 337 1112-1117.

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