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Acetaminophen Overdose

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By Matt Vera BSN, R.N.


  • Acetaminophen poisoning is an overdose of the over-the-counter (OTC) pain medication, acetaminophen (eg, Tylenol, Biogesic), which is usually safe when used as recommended.
  • The maximum daily dose of acetaminophen is four (4) grams, but patients with chronic diseases (especially liver disease) may need to limit themselves to three (3) grams a day.
  • Acetaminophen poisoning may occur as a result of one large dose or chronic overdoses.


An overdose of acetaminophen can result from:

  • Intentional overdose (eg, suicide attempt)
  • Accidental overdose (eg, unsupervised children, altered judgment regarding appropriate acetaminophen intake)
  • Combining medications that contain acetaminophen (Acetaminophen is found in more combination products than any other drug; examples include acetaminophen and codeine, as well as acetaminophen and aspirin.)
  • Toxic levels of acetaminophen may also occur in patients with liver failure who are taking recommended doses

Risk Factors

The following factors increase your chance of developing acetaminophen poisoning:

  • Age: 15-24 years or older than 40 years (People over 40 are more likely to have severe effects.)
  • Gender: female
  • Suicidal behavior


Symptoms include:

  • Nausea
  • Vomiting
  • Excessive sweating
  • Pale skin
  • Symptoms of liver failure:
    • Anorexia
    • Nausea
    • Vomiting
    • Malaise
    • Abdominal pain (especially in the upper right portion of the abdomen)
    • Pale skin
    • Excessive sweating
    • Jaundice
    • Confusion
    • Stupor


  • Blood Tests—Blood tests are done to determine the level of acetaminophen in your blood and to determine liver function (eg, liver enzyme tests, coagulation tests).
  • Rumack-Matthew Nomogram—This is an assessment to determine the effect on the liver. The test measures blood levels of acetaminophen relative to the time since ingestion of the medication.



  • For children who have relatively low levels of acetaminophen in their blood, monitoring at home may be recommended.

Activated Charcoal

  • Activated charcoal can help prevent acetaminophen from absorbing in the gastrointestinal tract. It is taken by mouth.


  • In most cases of toxic acetaminophen overdose, N-acetylcysteine, an amino acid, will be given by mouth or IV (through the vein) as an antidote.
Matt Vera, a registered nurse since 2009, leverages his experiences as a former student struggling with complex nursing topics to help aspiring nurses as a full-time writer and editor for Nurseslabs, simplifying the learning process, breaking down complicated subjects, and finding innovative ways to assist students in reaching their full potential as future healthcare providers.

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