Broadening the view of acetaminophen hepatotoxicity

Systematic review: prognostic tests of paracetamol‐induced acute liver failure

“…Whilst early and accurate prognostication in ALF is vital to permit timely listing for OLT, application of the KCC solely at admission reduces the time available for the disease to evolve and may introduce spectrum bias. Given that the median time taken to fulfil the KCC following admission to a tertiary liver transplant unit is 12 h, 7 application of the KCC solely at admission may explain the low sensitivity of the criteria in the US study, whilst concerns have also been expressed about the prophylactic use of fresh frozen plasma in this US study and the potential confounding effects upon prothrombin time 37 . Furthermore, 48% of cases resulted from unintentional overdoses in this US study, a type of overdose seen less frequently in the UK 38 .…”

Drug-induced liver disease

“…In an accompanying editorial [30 ], it was pointed out that only 40% of the alleged acetaminophen cases fulfilled the conventional diagnostic criteria of having an unambiguous history of an overdose coupled with a detectable acetaminophen serum concentration and extremely high aminotransferase levels. Furthermore, several cases very likely were not related to acetaminophen.…”

Paracetamol overdose in Victoria remains a significant health‐care burden

“…Paracetamol overdose is the most common cause of acute liver failure in Australia and is a well‐accepted indication for liver transplantation . Despite this, the majority of patients with paracetamol overdose have a good outcome …”