Peak serum acetaminophen levels after oral ingestion of tablets or capsules occur after 2 to 4 hours. Acute kidney injury due to proximal renal tubule damage is less frequent, affecting 25% of patients with severe liver damage and 50% of patients with liver failure caused by acetaminophen poisoning. In acute acetaminophen poisoning the liver is the critical organ with hepatocyte injury and necrosis. Ten-fold errors in the administration of parenteral acetaminophen have also resulted in toxicity. Acetaminophen ( INN paracetamol) poisoning is usually a result of an intentional (suicidal) overdose of oral formulations but may be also accidental from high doses taken for analgesia or due to accumulation of the drug in patients with severe liver disease.
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