Liver Failure Linked to Acetaminophen Overdose

A study has found that the risk of liver failure and death is increased in patients admitted to a hospital's intensive care unit (ICU) with accidental acetaminophen poisoning, compared to patients who have taken an intentional overdose. The reason is that accidental overdosers are more likely to be alcohol abusers and to go to the hospital later, both of which increase the risk of death. The study was published in Critical Care (2002;6:108-110; www.ccforum.com).

An overdose overwhelms the ability of the liver to process acetaminophen. The excess is processed into toxic chemicals and these can kill liver cells. US doctors analyzed the medical records of 93 patients hospitalized as the result of an overdose, of whom 80 were categorized as suicidal, or intentional overdoses, and 13 as accidental overdosers. The accidental overdosers did not do as well as those who had attempted suicide, in spite of the fact that their levels of acetaminophen were lower than those of patients who intentionally overdosed.

Further analysis showed that the accidental overdosers waited longer before going to the hospital, and treatment effectiveness by the drug N-acetylcysteine (NAC) is reduced if not provided within 12 hours. The analysis also revealed that the overdosers were more apt to be heavy drinkers of alcohol. The toxicity of acetaminophen is increased by alcohol, since the liver attempts to eliminate both the alcohol and the drug by a similar pathway.

Victims of acetaminophen poisoning are usually treated in the ICU, which places a large financial burden on hospitals, say the authors of the study. They believe that major cost savings could be accomplished by placing patients on medical floors rather than the ICU if they have intentionally overdosed and show no history of alcohol abuse.




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