Course Summary

Acetaminophen poisoning is the most common cause of acute liver failure in the United States and other countries. Acetaminophen overdose can cause renal and other organ system damage, although this is rare. After a chronic overdose, the toxic dose of acetaminophen depends on how long the patient has been taking the drug and the presence of risk factors. Use of the Rumack-Matthew nomogram helps to determine whether an acute acetaminophen ingestion can be expected to be toxic or non-toxic. In chronic acetaminophen use, a serum level should be measured to determine the need for treatment. The standard treatment for acetaminophen overdose is activated charcoal, and N-acetylcysteine if the clinician determines N-acetylcysteine is needed. Other antidotal therapies may also be considered. If a patient is treated appropriately and promptly, the prognosis is typically good. In some cases, liver transplantation is needed.

Course Format


Course Syllabus

  • Introduction
  • Incidence of Acetaminophen Overdose
  • Acetaminophen: Pharmacology
    • Labeled Uses and Mechanism of Action
    • Pharmacokinetics
    • Dosing
    • Available Forms
    • Contraindications, Cautions and Side Effects
    • Drug-Drug Interactions
  • Acetaminophen: Toxic Dose
  • Therapeutic Dose and Toxicity
  • Repeated Supratherapeutic Ingestion and Overdose
  • Clinical Presentation of Acetaminophen Poisoning
    • Phase I
    • Phase II
    • Phase III
    • Phase IV
    • Renal and Other Organ Injury
  • Risk Factors of Acetaminophen Poisoning
    • Alcohol and Acetaminophen Poisoning
    • Age
    • Genetics
    • Chronic Liver Disease
    • Poor Nutritional Status
    • Cigarette Smoking
    • Medications
    • Intrahepatic Glutathione Levels
    • Acute Viral Illness
  • Diagnosis of Acute Acetaminophen Overdose
    • Serum Acetaminophen Level
    • Laboratory Tests
    • Rumack-Matthew Nomogram
    • Repeated Supratherapeutic Ingestion, Delayed Presentation, and Unknown Time of Ingestion
  • Treatment of Acetaminophen Overdose
    • Activated Charcoal
    • N-Acetylcysteine (NAC)
    • Fomepizole
    • Acetaminophen Overdose: Ambiguous and/or Missing Data
  • Special Cases of Acetaminophen Poisoning: Pregnancy and Liver Failure
    • Pregnancy and Acetaminophen Overdose
    • Acute Liver Failure
  • Case Study: Acetaminophen Poisoning
    • Discussion
  • Summary


Dana Bartlett, RN, BSN, MSN, MA, CSPI

Dana Bartlett is a professional nurse and author. His clinical experience includes 16 years of ICU and ER experience and over 27 years as a poison control center information specialist. Dana has published numerous CE and journal articles, written NCLEX material, textbook chapters, and more than 100 online CE articles, and done editing and reviewing for publishers such as Elsevier, Lippincott, and Thieme. He has written widely on the subject of toxicology and was a contributing editor, toxicology section, for Critical Care Nurse journal. He is currently employed at the Connecticut Poison Control Center. He lives in Wappingers Falls, NY.

Kellie Wilson, PharmD

Kellie Wilson is a Doctor of Pharmacy practicing in Anaconda, Montana, where she lives with her husband and four children. She attended the University of Montana in Missoula where she graduated in 2009 with a doctorate in pharmacy. She later worked in Boise, Idaho for a large, retail pharmacy for 2 years, and then returned home to Montana to oversee an independently owned retail and long-term care pharmacy in Anaconda. As an independent retail pharmacist she has become very involved in psychiatric pharmacy for two major behavioral health organizations that are located around all of Montana. Kellie’s passion is retail pharmacy because she enjoys the interactions with customers as well as the challenges and rewards of staying current with the continuous changes in the pharmacy field.

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