However, reports have indicated hepatic necrosis with a single dose of 6 g and death occurring with a single dose of 13 g. Nonfatal overdoses of 12.5 to 31.5 g have also been reported. The earliest symptoms of overdose with acetaminophen are nausea, vomiting, sweating and pallor. This initial period is frequently followed by an asymptomatic phase of 24 to 48 hours after which hepatic damage may become evident. Elevation in hepatic enzymes, AST, ALT are noted. Urea remains low.
Hepatic function is altered as measured by bilirubin and prothrombin time.
The liver enlarges with marked right upper quadrant pain and tenderness. After 3 to 5 days, jaundice, hypoglycemia, encephalopathy, cardiomyopathy, renal failure, hepatic coma and death may occur. Most clinicians feel that the half-life is not a good predictor and it has actually fallen into disfavor. Empty the stomach. Follow with activated charcoal and a cathartic.