However, in the first 12hrs hours after acute ingestion, liver enzymes are expected to be normal. The typical threshold for toxicity is 200 mg/kg acetaminophen for the acute one time dose.Īll patients with poor outcomes after acetaminophen overdose will have elevated liver enzymes by the 24 hr mark. Have a low threshold for obtaining serum acetaminophen levels in patients with any overdose self-harm attempt, unexplained altered level of awareness with metabolic acidosis and unexplained elevated liver enzymes. Laboratory investigations and risk stratification in acetaminophen poisoning The stages of acetaminophen poisoning occur after a single recent overdose Other factors on presentation that are associated with poor outcomes or death include: Pitfall #3 is failure to recognize patient factors that may potentiate or augment acetaminophen toxicity including other medications, co-ingestions, chronic alcohol use and malnutrition.
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