Liver toxicity after acetaminophen ingestion. Inadequacy of the dose estimate as an index of risk
J. Ambre and M. Alexander
With increasing frequency, the physician is confronted with the problem of
determining the risk of liver toxicity in a person who may have ingested an
overdose of acetaminophen. To be effective, antidotal therapy must be given
early after acetaminophen ingestion when the patient, despite the toxic
injury occurring in his liver, may appear quite well. We have reviewed the
cases of the first five persons who came to our institution with a history
of having ingested a large overdose of acetaminophen. In each case plasma
or serum acetaminophen levels were low and substantial liver injury did not
occur. Measurement of acetaminophen levels, indicating the amount of drug
absorbed, were a more reliable index of the risk of toxic liver injury and
the need for antidotal therapy than the estimate of the dose ingested.
