ACETAMINOPHEN TOXICITY IN AN URBAN COUNTY HOSPITAL

Background The prevalence and characteristics of acetaminophen associa ted liver injury in hospitalized patients are not well defined. Method s We identified patients hospitalized for excessive acetaminophen inge stion at an urban county hospital over a 40-month period (1992 to 1995 ) and reviewed their medical records to determine the incidence and cl inical features of the ingestions and their outcomes. Results Of the 7 1 patients studied, 50 were classified as having taken acetaminophen d uring suicide attempts and 21 as having accidentally poisoned themselv es while attempting to relieve pain, The suicidal patients had ingeste d almost twice as much acetaminophen as those in the accidental-overdo se group (median, 20 vs. 12 g; P=0.009), Among the patients for whom d ata were available, 63 percent of those in the accidental-overdose gro up and 25 percent of those in the suicidal group were chronic alcohol abusers (P=0.009). The patients in the accidental-overdose group more often had severe liver necrosis (aminotransferase levels, >3500 IU per liter; 52 percent vs, 14 percent; P=0.002) and were more likely to ha ve hepatic coma (33 percent vs. 6 percent, P=0.006). There were four d eaths (19 percent) in the accidental-overdose group and one (2 percent ) in the suicidal group (P=0.04). Five patients - three in the acciden tal-overdose group and two in the suicidal group - had ingested 4 g of acetaminophen or less. Acetaminophen ingestion accounted for 12 perce nt of all patients hospitalized with overdoses (71 of 589) and 40 perc ent of patients with acute liver failure (10 of 25) during the study p eriod. Conclusions In an urban county hospital, patients hospitalized with acetaminophen toxicity related to accidental misuse had higher ra tes of morbidity and mortality than those who attempted suicide, even though the latter had taken more acetaminophen. A higher frequency of chronic alcohol abuse among the patients with accidental overdoses may be one explanation. (C) 1997, Massachusetts Medical Society.