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Greater than 50 mcg/mL 12 hours after ingestionĪssociated with toxicity and liver damage
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Greater than 200 mcg/mL 4 hours after ingestion Less than 150 mcg/mL 4 hours after ingestion
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The table below summarizes some results that may be seen: Acetaminophen Level If treatment is received within 8 hours of the overdose, however, there is a very good chance of recovery.įor children who have taken acetaminophen in liquid form, a treatment decision may be made as soon as 2 hours after ingestion since the drug is absorbed more rapidly in this form. If untreated, toxicity can progress within 3 to 4 days to include jaundice, liver and kidney failure, convulsions, coma and death. These can appear as early as 2 to 3 hours after ingestion or may not occur for 12 or more hours. Testing may be ordered when a person has signs and symptoms of an overdose. Samples collected too soon after ingestion may not accurately reflect the amount absorbed from the stomach into the blood. Healthcare practitioners may order acetaminophen levels beginning at 4 hours after ingestion or possible ingestion and then every 4 to 6 hours to monitor whether the drug level is increasing or decreasing. Prompt diagnosis and treatment are important for a positive outcome. The test for acetaminophen is used to measure the level of drug in the blood in order to establish a diagnosis of overdose, to assess the risk of liver damage, and to help decide on the need for treatment. However, study data from England suggest that NAC may be beneficial for acetaminophen-induced liver failure more than 24 hours after ingestion. Until recently, NAC for people who visit healthcare providers later than 24 hours after acetaminophen ingestion was not the standard of care for acetaminophen overdose management in the United States. Though NAC is ideally administered within this timeframe, people who seek treatment more than 12 hours after ingestion may still be given the antidote. If a health practitioner determines that an overdose has occurred, treatment may include an antidote, N-acetylcysteine (NAC), which can help minimize damage to the liver, especially if given within 8 to 12 hours after an overdose. If it is known or suspected that someone has ingested an overdose of acetaminophen, it is recommended to take the person to the emergency room. (For more on this, see the MayoClinic webpage Acetaminophen and children: Why dose matters.)
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When a large dose of acetaminophen is ingested or that exceeds the recommended amount over a period of time, the liver is no longer able to produce enough protective glutathione as a result, the toxic byproduct builds up in the liver and may cause severe liver damage if timely treatment is not given.įor this reason, acetaminophen can be harmful or even fatal if not taken correctly and children in particular are at risk if caregivers do not follow dosing instructions carefully. Fortunately, your liver makes a antioxidant called glutathione that binds to the byproduct and minimizes its toxic effects. However, about 5 to 10% of the absorbed acetaminophen is converted to a toxic, highly-reactive byproduct. Once entering your body, like many other medications, acetaminophen is processed in the liver into harmless substances and removed in your urine. However, it is also the most common cause of toxic hepatitis in North America and Europe and one of the most common poisonings from either accidental or intentional overdose. Acetaminophen is one of the most common pain relievers (analgesics) and fever reducers (antipyretics) available over the counter.
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