Acetaminophen overdose

Given the ubiquity of acetaminophen and the lack of symptoms, or the nonspecific symptoms associated with initial acetaminophen toxicity, potential unsuspected acetaminophen toxicity is a concern in acute overdose or repeated supratherapeutic ingestions. Though, the overall risk of unsuspected acetaminophen toxicity in acute suicidal ingestions is low, and some studies have questioned the routine check of serum acetaminophen in all patients presenting with a history of intentional self-harm, many toxicology experts recommend that the risk of this treatable life-threatening overdose warrants universal acetaminophen screening in all suicidal ingestions.[73]Lucanie R, Chiang WK, Reilly R. Utility of acetaminophen screening in unsuspected suicidal ingestions. Vet Hum Toxicol. 2002 Jun;44(3):171-3. http://www.ncbi.nlm.nih.gov/pubmed/12046974?tool=bestpractice.com [74]Sporer KA, Khayam-Bashi H. Acetaminophen and salicylate serum levels in patients with suicidal ingestion or altered mental status. Am J Emerg Med. 1996 Sep;14(5):443-6. http://www.ncbi.nlm.nih.gov/pubmed/8765104?tool=bestpractice.com

All patients who present in coma or with decreased levels of consciousness and are thought to have taken an overdose or self-harmed in any other way should have a serum acetaminophen level checked. A serum AST or ALT in addition to the acetaminophen level should be obtained in patients with a history of frequent or repeated use of medications for pain relief.