Prognosis

Prognosis is related to the degree of encephalopathy, coagulopathy, and acidosis.[5]​ Acetylcysteine is nearly 100% effective when started within 8 hours after ingestion.[4][85]​ Treatment delays beyond 8 hours are associated with stepwise increases in risk of hepatotoxicity, transplant, and death.[4][108]

Liver injury usually becomes maximal at 72-96 hours. Although most patients will recover, some may progress to have fulminant hepatic failure with encephalopathy, coma, and renal failure (hepatorenal syndrome), and rarely, hemorrhage.[53][54][55][56][57] In survivors, hepatic regeneration is normally rapid and complete, with normalization of liver function tests within 1 to 3 weeks.[62][63][109]​​ Abnormalities of prothrombin time, glucose, lactate, creatinine, pH, and phosphate, are more important markers of prognosis than the degree aminotransferase elevation.[58][59]

In unselected patients, even without specific treatment, the prognosis is usually good with <10% developing hepatotoxicity; 1% acute renal failure; and a 1% to 2% mortality rate (due to hepatic failure).[53]​ An increased risk of severe hepatotoxicity and higher mortality has been reported in patients with staggered overdoses or delayed presentation.[110]

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