The occurrence of hepatotoxicity and acute renal dysfunction following an acute paracetamol overdose has been well documented. Acute pancreatitis, however, has been rarely described. We would like to report a hemodialysis patient who developed acute pancreatitis and hepatic failure from acute paracetamol toxicity. To our knowledge, this represents the first description in a dialysis patient of paracetamol induced pancreatitis. Given the frequency of paracetamol usage in these patients, we believe that it is important to consider this diagnosis in patients with unexplained acute pancreatitis, particularly if there is associated hepatic dysfunction.