Course Summary

Acetaminophen poisoning is a leading cause of drug-induced liver injury in the United States, often resulting from unintentional overdoses or intentional ingestion. Acetaminophen is widely used for pain and fever management, but excessive doses lead to the accumulation of its toxic metabolite, N-acetyl-p-benzoquinone imine (NAPQI), which causes hepatocellular damage. Toxicity progresses through four stages, ranging from nonspecific symptoms like nausea and vomiting to severe liver failure and death in untreated cases. Early recognition is critical, as timely administration of N-acetylcysteine (NAC) effectively detoxifies NAPQI and prevents severe outcomes.

Course Format

Homestudy

Course Syllabus

• Introduction
• Pharmacological Profile
  • Mechanism of Action, Effects, Clinical Indications
  • Dosing and Administration
  • Warnings, Precautions, Adverse Effects
  • Drug-Drug Interactions
• Monitoring: Laboratory Testing and Follow-up
• Laboratory Testing
• Acetaminophen Toxicity
  • Intentional Overdose
  • Unintentional Overdose
  • Mechanism and Normal Metabolism
  • NAPQI Detoxification and Toxic Overdose
  • Hepatocellular Damage
• Clinical Presentation of Toxicity
  • Initial Phase (0–24 hours)
  • Second Phase: Hepatic Injury Phase (24–72 hours)
  • Third Phase: Hepatic Failure Phase (72–96 hours)
  • Fourth Phase: Recovery or Death Phase (4–14 days)
• Medical Management of Toxicity
  • Immediate Assessment and Activated Charcoal
  • N-Acetylcysteine (NAC) Therapy
  • Monitoring and Supportive Care
  • Special Populations
  • Liver Transplantation
• Rumack-Matthew Nomogram
  • Use of the Nomogram
• Case Study: 18-year-old male
• Poison Control
  • How to Contact Poison Control
  • What Poison Control Provides
• Psychiatric Referral: Intentional Overdose
• Interprofessional Health Team Approach
• Communication and Treatment Plan Documentation
• Clinical Pearls
• Case Study: Acetaminophen Overdose and Renal Complications
• Summary

Authors

Richard Daniels, PharmD, BCPS

Richard “Cole” Daniels earned his Doctor of Pharmacy(PharmD) from the Skaggs School of Pharmacy at the University of Montana in 2018. Throughout pharmacy school he completed a 3-year internship at Community Medical Center in Missoula, Montana in which he gained valuable experience in an acute care setting. Cole currently serves as a psychiatric clinical staff pharmacist at the Montana State Hospital. He has over 11 years of pharmacy experience having worked in several settings including retail, acute care, and inpatient psychiatric care. Cole has a diverse set of interests. However, acute care medicine, infectious disease, pain management, and asthma/COPD are a primary focus of his at the Montana State Hospital. He obtained board certification as a certified pharmacotherapy specialist in the Spring of 2022.

Elisabeth Gordon, BScPharm, RPh

Elisabeth Gordon earned her BSc(Pharm) from the University of British Columbia in 2004. After graduation, she worked in community retail pharmacies on Vancouver Island, before returning to her rural hometown of Salmon Arm. In 2016 and 2017, Elisabeth trained with Pallium Canada and Victoria Hospice to enhance her knowledge of end-of-life-care and palliative services. She is a volunteer medical supervisor for T1DOutreach, a peer support platform for adults living with type 1 diabetes, and a member of a Canadian peer support group for adults living with Birdshot Uveitis. Elisabeth enjoys working in a small, fast-paced rural pharmacy where she brings compassion and empathy to her everyday practice.