Pathophysiology: Depletion of intrahepatic glutathione → accumulation of NAPQI (N-acetyl-p-benzoquinone imine, a toxic metabolite of acetaminophen)

Clinical features (time from ingestion):
≤24 hr: Asymptomatic or nonspecific symptoms (eg, nausea, vomiting, fatigue)
24-72 hr: ↑ AST, ALT
72-96 hr:
AST/ALT levels peak (sometimes over 10,000 U/L)
Severe cases: ↑ PT/PTT, hypoglycemia, lactic acidosis, ↑ bilirubin, acute kidney injury
4-14 days: Recovery

Diagnosis:
Serum acetaminophen level (4-24 hr)
Liver function tests, BUN/creatinine, electrolytes

Treatment / management:
Activated charcoal (if less than 4 hr)
N-acetylcysteine

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