It has also been suggested that recent fasting is associated with hepatotoxicity in patients taking higher than recommended doses. The risk of renal complications appears to be higher in alcoholic patients. Recently, acetaminophen has been implicated as a contributing factor in the decline of renal function in patients with underlying renal disease, including diabetic nephropathy. Methemoglobinemia can occur after acute overdoses of acetaminophen and can lead to hemolysis thereby causing hemolytic anemia. This can result in cyanosis of the fingernails, skin, and mucosa.
Children develop methemoglobinemia more readily than do adults.
Other hematologic reactions reported with acetaminophen include neutropenia, leukopenia, thrombocytopenia, and pancytopenia. These can only be provided by a physician who has had an opportunity to interact with a patient in person and at length, with access to the patient's previous records and appropriate follow-up.