A 7-year experience of severe acetaminophen-induced hepatotoxicity (1987-1993)

Gastroenterology. 1995 Dec;109(6):1907-16. doi: 10.1016/0016-5085(95)90758-0.


Background & aims: Five hundred sixty patients admitted between January 1, 1987, and December 31, 1993, with severe acetaminophen-induced hepatotoxicity were studied. The aim of this study was to identify why severe acetaminophen-induced hepatotoxicity still occurs and to determine how known risk factors and advances in management have affected the pattern of illness and outcome.

Methods: This was a retrospective study of the etiologic factors and the clinical course of all acetaminophen-related admissions.

Results: The number of admissions increased from 58 in 1987 to 123 in 1993. During the corresponding period, overall survival improved from just < 50% to 78%. The percentage of admissions treated with N-acetylcysteine increased from 40% in 1987 to 83% in 1993. The frequency with which grade III or IV encephalopathy developed decreased from 62% in 1987 to 40% in 1993, and the percentage of these patients who developed cerebral edema decreased from 61% to 45% during the same period. There was an increase in both the number of patients transplanted and the survival of those managed medically.

Conclusions: Severe acetaminophen-induced hepatotoxicity remains a serious condition, but the increasing use of N-acetylcysteine, advances in medical management, and the increasing availability of transplantation have resulted in a significant improvement in survival rates.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetaminophen / poisoning*
  • Acetylcysteine / therapeutic use
  • Adolescent
  • Adult
  • Aged
  • Analgesics, Non-Narcotic / poisoning*
  • Brain Edema / chemically induced
  • Chi-Square Distribution
  • Drug Overdose
  • Female
  • Hepatic Encephalopathy / chemically induced
  • Humans
  • Liver / drug effects*
  • Liver Failure / chemically induced*
  • Liver Failure / mortality
  • Liver Failure / therapy
  • Liver Transplantation
  • Male
  • Middle Aged
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Survival Rate


  • Analgesics, Non-Narcotic
  • Acetaminophen
  • Acetylcysteine