Commentary

Acetaminophen poisoning: an update for the intensivist

Paul I Dargan¹ and Alison L Jones²

¹Specialist Registrar in Medicine and Clinical Toxicology, National Poisons Information Service, Guy's & St Thomas' NHS Trust, London, UK

²Consultant Physician and Clinical Toxicologist, National Poisons Information Service, Guy's & St Thomas' NHS Trust, London, UK

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Critical Care 2002, 6:108-110doi:10.1186/cc1465

Published:	14 March 2002

See related Research article: http://ccforum.com/content/6/2/155

Abstract

Acetaminophen overdose is common and can result from deliberate/nonstaggered or accidental/staggered ingestion. Patients presenting within 24 h of an acetaminophen overdose can safely be managed on medical wards. Early management of nonstaggered overdose is guided by the plasma acetaminophen concentration, whereas management of accidental/staggered ingestion is guided by ingested dose. Ingested dose and time from ingestion to presentation are important prognostic factors in accidental/staggered ingestion. Acetaminophen-induced acute liver failure (ALF) requires meticulous supportive care in an intensive care unit (ICU), with early identification and transfer of patients who are likely to require liver transplantation to a specialist liver centre. The modified King's College Hospital criteria (incorporating lactate into the traditional criteria) represent the best tool for identifying patients who require transplantation.