Which consultations are indicated in acetaminophen toxicity/poisoning?

Updated: Jan 17, 2020
  • Author: Susan E Farrell, MD; Chief Editor: Michael A Miller, MD  more...
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Answer

Consultation with a medical toxicologist is recommended for patients who have a complicated or late presentation, hepatic or renal dysfunction, or a history of potentially toxic co-ingestants. Medical toxicologists are available through consultation with a regional poison control center. For ingestions seen as a "cry for help" or as an intent to self-harm, psychosocial, psychological and/or psychiatric evaluations are required.

A hepatologist who is directly affiliated with a transplantation medical center should be consulted in the setting of hepatic dysfunction and liver failure. Concurrently, consult a transplantation surgeon in the setting of clinical and laboratory indicators that are highly predictive of death unless urgent transplantation is undertaken (see Prognosis). The United Kingdom King's College Hospital criteria for the determination of the urgent need for transplantation after acetaminophen-induced fulminant hepatic failure include any one of the following:

  • Arterial pH less than 7.3 after fluid resuscitation

  • Grade III or IV encephalopathy

  • Prothrombin time (PT) greater than 100 seconds

  • Serum creatinine level greater than 3.4 mg/dL


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