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Acetaminophen (APAP) is a widely used drug in our environment with few adverse effects. Because of this, several patients affected by APAP hepatotoxicity unknown that the APAP dose-intake was excessive. This damage is mainly produced via one of APAP metabolites: N-acetyl-para-benzo-quinone imine (NAPQI), which is very toxic. The drug’s ingested doses as well as the length of time from APAP ingestion to N-acetylcysteine (NAC) therapy are the most essential determining factors in both the development and severity of APAP hepatotoxicity. However, there are other factors related, including alcohol intake, herbs and medications, age and genetic factors, nutritional status, and chronic liver disease. The ingestion of a toxic dose of APAP causes different clinical manifestations that depend fundamentally on the time elapsed since the intake. The diagnosis process depends on the intake (acute single overdose of after repeated overdoses). The Rumack-Matthew nomogram is acceptable after an acute single overdose, being the “possible hepatic toxicity” point 200 µg/mL at 4 hours and 25 µg/mL at 16 hours). This normogram is no applicable in after repeated overdoses. NAC is the antidote for APAP intoxication, and could be administered orally or intravenous. Finally, a multidisciplinary approach with the support of Psychiatry, Intensive Care Unit as well as Gastroenterology and Digestive Department will be necessary, especially in the case of attempted autolysis and severe liver failure., {"references":["Bunchorntavakul C, Reddy KR. Acetaminophen-related Hepatotoxicity. Clin Liver Dis 2013;17:587-607. doi:10.1016/j.cld.2013.07.005.","Herndon CM, Dankenbring DM. Patient perception and knowledge of acetaminophen in a large family medicine service. J Pain Palliat Care Pharmacother 2014;28:109-16. doi:10.3109/15360288.2014.908993.","Graham GG, Scott KF. Mechanism of action of paracetamol. 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In the preceding "Insight" piece, Gray and Graham (GG Finkel, 1990]. Recommendations made in ignorance of uncertainty are vulnerable to four common pitfalls: (1) they do not allow for the weighing of the probabilities and the consequences of error; (2) they do not permit a reliable comparison of the costs and benefits of a portfolio of decisions, so that priorities can be established; (3) they fail to communicate to decision makers and the public the range of control options that would be compatible with different assessments of the true state-of-nature; and (4) they preclude the opportunity for identifying research initiatives that might reduce uncertainty and thereby reduce the probability or the impact of being caught by surprise. In selecting for analysis EPA's estimate of the annual excess death toll from carcinogenic air pollutants, G&G reveal the flaws in a particularly important "risk number" that EPA presents in a particularly clumsy fashion. As they indicate, it is easy for the reader of Cancer Risk from Outdoor Exposure to Air Toxics to infer that the interval 1734-2597 is meant to subsume the total

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