Fast Five Quiz: Can You Recognize and Treat Over-the-Counter Drug Abuse and Toxicity?

Mary L. Windle, PharmD


January 13, 2017

Most patients who overdose on acetaminophen will initially be asymptomatic, as clinical symptoms of end-organ toxicity do not manifest until 24-48 hours after an acute ingestion. Therefore, to identify a patient who may be at risk for hepatotoxicity, the clinician should determine the time(s) of ingestion, the quantity, and the formulation of acetaminophen ingested. Acetaminophen is contained in numerous cough and cold, flu, migraine, allergy, and pain OTC combination products; thus, the patient may be unaware of how much acetaminophen they are consuming on a daily basis.

Minimum toxic doses of acetaminophen for a single ingestion, posing significant risk for severe hepatotoxicity, are as follows:

  • Adults: 7.5-10 g

  • Children: 150 mg/kg; 200 mg/kg in healthy children aged 1-6 years

Some patients may report decreased urinary output (oliguria) 18-72 hours after ingestion.

For more on acetaminophen overdose, read here.


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