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Cited by 422Drug-Induced Hepatotoxicity and ProtectionPoisoning and overdose treatmentsOpioid Use Disorder Treatment

Acetaminophen Toxicity in an Urban County Hospital

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Schiødt, Frank V., Rochling, Fedja A., Casey, Donna L., Lee, William M.·1997·New England Journal of Medicine
DOI 10.1056/nejm199710163371602
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Abstract

BACKGROUND: The prevalence and characteristics of acetaminophen-associated liver injury in hospitalized patients are not well defined. METHODS: We identified patients hospitalized for excessive acetaminophen ingestion at an urban county hospital over a 40-month period (1992 to 1995) and reviewed their medical records to determine the incidence and clinical features of the ingestions and their outcomes. RESULTS: Of the 71 patients studied, 50 were classified as having taken acetaminophen during suicide attempts and 21 as having accidentally poisoned themselves while attempting to relieve pain. The suicidal patients had ingested almost twice as much acetaminophen as those in the accidental-overdose group (median, 20 vs. 12 g; P=0.009). Among the patients for whom data were available, 63 percent of those in the accidental-overdose group and 25 percent of those in the suicidal group had chronic alcohol abuse (P=0.009). The patients in the accidental-overdose group more often had severe liver necrosis (aminotransferase levels, >3500 IU per liter; 52 percent vs. 14 percent; P=0.002), and were more likely to have hepatic coma (33 percent vs. 6 percent, P=0.006). There were four deaths (19 percent) in the accidental-overdose group and one (2 percent) in the suicidal group (P=0.04). Five patients -- three in the accidental-overdose group and two in the suicidal group -- had ingested 4 g of acetaminophen or less. Acetaminophen ingestion accounted for 12 percent of all patients hospitalized with overdoses (71 of 589) and 40 percent of patients with acute liver failure (10 of 25) during the study period. CONCLUSIONS: In an urban county hospital, patients hospitalized with acetaminophen toxicity related to accidental misuse had higher rates of morbidity and mortality than those who attempted suicide, even though the latter had taken more acetaminophen. A higher frequency of chronic alcohol abuse among the patients with accidental overdoses may be one explanation.

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  1. Er- ratum, N Engl J Med 1994;330:584.]
  2. Makin AJ, Williams R. Acetaminophen-induced acute liver failure. In: Lee WM, Williams R, eds. Acute liver failure. Cambridge, England: Cam- bridge University Press, 1997:32-42.

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Authors
Schiødt, F. V., Rochling, F. A., Casey, D. L., & Lee, W. M.
Affiliations
The University of Texas Southwestern Medical Center (US)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
1997-10-16
Volume
337
Issue
16
Pages
1112-1118
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejm199710163371602
OpenAlex
W2333982488
Cited by
422
References
29
Citations by year
2026: 2 · 2025: 6 · 2024: 5 · 2023: 6 · 2022: 5 · 2021: 5 · 2020: 16 · 2019: 9 · 2018: 13 · 2017: 13 · 2016: 14 · 2015: 14 · 2014: 7 · 2013: 11 · 2012: 18
FWCI
20.22
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Drug-Induced Hepatotoxicity and Protection
  • Health Sciences › Medicine › Emergency Medicine › Poisoning and overdose treatments
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Keywords
acetaminophen toxicity, acetaminophen overdose, drug-induced liver injury, acute liver failure, suicide attempts, accidental poisoning, chronic alcohol abuse, hepatic coma, liver necrosis, drug overdose deaths, hospitalized patients
MeSH terms
Accidents, Acetaminophen, Adolescent, Adult, Aged, Aged, 80 and over, Alcoholism, Female, Hospitals, County, Hospitals, Urban, Humans, Liver Diseases, Male, Middle Aged, Poisoning, Retrospective Studies, Suicide, Attempted, Texas, Chemical and Drug Induced Liver Injury

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