Guidelines
Wolf SJ, Heard K, Sloan EP, Jagoda AS; American College of Emergency Physicians. Clinical policy: critical issues in the management of patients presenting to the emergency department with acetaminophen overdose. Ann Emerg Med. 2007 Sep;50(3):292-313. doi: 10.1016/j.annemergmed.2007.06.014. PMID: 17709050.
Guidelines for the Management of Acetaminophen Overdose- https://www.tylenolprofessional.com/sites/tylenol_hcp_us/files/acetaminphen_overdose_treatment_info.pdf
Chiew AL, Reith D, Pomerleau A, Wong A, Isoardi KZ, Soderstrom J, Buckley NA. Updated guidelines for the management of paracetamol poisoning in Australia and New Zealand. Med J Aust. 2020 Mar;212(4):175-183. doi: 10.5694/mja2.50428. Epub 2019 Dec 1. PMID: 31786822.
Chiew AL, Fountain JS, Graudins A, Isbister GK, Reith D, Buckley NA. Summary statement: new guidelines for the management of paracetamol poisoning in Australia and New Zealand. Med J Aust. 2015 Sep 7;203(5):215-8. doi: 10.5694/mja15.00614. Erratum in: Med J Aust. 2015 Oct 19;203(8):320. Erratum in: Med J Aust. 2016 Aug 15;205(4):167. PMID: 26852051.
Treatment of Paracetamol Overdose- https://handbook.ggcmedicines.org.uk/guidelines/drug-overdose-and-toxicity/treatment-of-paracetamol-overdose/
Primary Literature
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Wong A, McNulty R, Taylor D, Sivilotti M, Greene S, Gunja N, Koutsogiannis Z, Graudins A. The NACSTOP Trial: A Multicenter, Cluster-Controlled Trial of Early Cessation of Acetylcysteine in Acetaminophen Overdose. 2019 Feb;69(2):774-784. doi: 10.1002/hep.30224. Epub 2019 Jan 19. PMID: 30125376.
Smilkstein MJ, Bronstein AC, Linden C, Augenstein WL, Kulig KW, Rumack BH. Acetaminophen overdose: a 48-hour intravenous N-acetylcysteine treatment protocol. Ann Emerg Med. 1991 Oct;20(10):1058-63. doi: 10.1016/s0196-0644(05)81352-6. PMID: 1928874.
Waring WS, Stephen AF, Robinson OD, Dow MA, Pettie JM. Lower incidence of anaphylactoid reactions to N-acetylcysteine in patients with high acetaminophen concentrations after overdose. Clin Toxicol (Phila). 2008 Jul;46(6):496-500. doi: 10.1080/15563650701864760. PMID: 18584360.
Montoya-Cabrera MA, Escalante-Galindo P, Nava-Juárez A, Terroba-Larios VM, Terán-Hernández JA. Evaluación de la eficacia de la N-acetilcisteina administrada sola o combinada con carbón activado en el tratamiento de la sobredosis por acetaminofén [Evaluation of the efficacy of N-acetylcysteine administered alone or in combination with activated charcoal in the treatment of acetaminophen overdoses]. Gac Med Mex. 1999 May-Jun;135(3):239-43. Spanish. PMID: 10425820.
Chiew AL, James LP, Isbister GK, Pickering JW, McArdle K, Chan BSH, Buckley NA. Early acetaminophen-protein adducts predict hepatotoxicity following overdose (ATOM-5). J Hepatol. 2020 Mar;72(3):450-462. doi: 10.1016/j.jhep.2019.10.030. Epub 2019 Nov 22. PMID: 31760072.
Morrison EE, Oatey K, Gallagher B, Grahamslaw J, O’Brien R, Black P, Oosthuyzen W, Lee RJ, Weir CJ, Henriksen D, Dear JW; POP Trial Investigators. Principal results of a randomised open label exploratory, safety and tolerability study with calmangafodipir in patients treated with a 12 h regimen of N-acetylcysteine for paracetamol overdose (POP trial). 2019 Aug;46:423-430. doi: 10.1016/j.ebiom.2019.07.013. Epub 2019 Jul 13. PMID: 31311721; PMCID: PMC6710902.
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Wright RO, Anderson AC, Lesko SL, Woolf AD, Linakis JG, Lewander WJ. Effect of metoclopramide dose on preventing emesis after oral administration of N-acetylcysteine for acetaminophen overdose. J Toxicol Clin Toxicol. 1999;37(1):35-42. doi: 10.1081/clt-100102406. PMID: 10078158.
Heard K, Rumack BH, Green JL, Bucher-Bartelson B, Heard S, Bronstein AC, Dart RC. A single-arm clinical trial of a 48-hour intravenous N-acetylcysteine protocol for treatment of acetaminophen poisoning. Clin Toxicol (Phila). 2014 Jun;52(5):512-8. doi: 10.3109/15563650.2014.902955. Epub 2014 Apr 8. PMID: 24708414.
Wong A, Nejad C, Gantier M, Choy KW, Doery J, Graudins A. MicroRNA from a 12-h versus 20-h acetylcysteine infusion for paracetamol overdose. Hum Exp Toxicol. 2019 Jun;38(6):646-654. doi: 10.1177/0960327119833740. Epub 2019 Mar 6. PMID: 30838890.
Wong A, Homer N, Dear JW, Choy KW, Doery J, Graudins A. Paracetamol metabolite concentrations following low risk overdose treated with an abbreviated 12-h versus 20-h acetylcysteine infusion. Clin Toxicol (Phila) . 2019 May;57(5):312-317. doi: 10.1080/15563650.2018.1517881. Epub 2018 Nov 19. PMID: 30453788.
Keays R, Harrison PM, Wendon JA, Forbes A, Gove C, Alexander GJ, Williams R. Intravenous acetylcysteine in paracetamol induced fulminant hepatic failure: a prospective controlled trial. BMJ. 1991 Oct 26;303(6809):1026-9. doi: 10.1136/bmj.303.6809.1026. PMID: 1954453; PMCID: PMC1671790.
Bateman DN, Dear JW, Thanacoody HK, Thomas SH, Eddleston M, Sandilands EA, Coyle J, Cooper JG, Rodriguez A, Butcher I, Lewis SC, Vliegenthart AD, Veiraiah A, Webb DJ, Gray A. Reduction of adverse effects from intravenous acetylcysteine treatment for paracetamol poisoning: a randomised controlled trial. Lancet. 2014 Feb 22;383(9918):697-704. doi: 10.1016/S0140-6736(13)62062-0. Epub 2013 Nov 28. Erratum in: Lancet. 2016 May 7;387(10031):1908. PMID: 24290406.
Hassig SR, Linscheer WG, Murthy UK, Miller C, Banerjee A, Levine L, Wagner K, Oates RP. Effects of PEG-electrolyte (Colyte) lavage on serum acetaminophen concentrations. A model for treatment of acetaminophen overdose. Dig Dis Sci. 1993 Aug;38(8):1395-401. doi: 10.1007/BF01308594. PMID: 8344093.
Owens KH, Medlicott NJ, Zacharias M, Whyte IM, Buckley NA, Reith DM. Population pharmacokinetic-pharmacodynamic modelling to describe the effects of paracetamol and N-acetylcysteine on the international normalized ratio. Clin Exp Pharmacol Physiol. 2015 Jan;42(1):102-8. doi: 10.1111/1440-1681.12327. PMID: 25316328.
Yip L, Dart RC. A 20-hour treatment for acute acetaminophen overdose. N Engl J Med. 2003 Jun 12;348(24):2471-2. doi: 10.1056/NEJM200306123482422. PMID: 12802041.
Schiødt FV, Rochling FA, Casey DL, Lee WM. Acetaminophen toxicity in an urban county hospital. N Engl J Med. 1997 Oct 16;337(16):1112-7. doi: 10.1056/NEJM199710163371602. PMID: 9329933.
Shah KR, Beuhler MC. Fomepizole as an Adjunctive Treatment in Severe Acetaminophen Toxicity. Am J Emerg Med. 2020 Feb;38(2):410.e5-410.e6. doi: 10.1016/j.ajem.2019.09.005. Epub 2019 Nov 16. PMID: 31785979.
Woolum JA, Hays WB, Patel KH. Use of fomepizole, n-acetylcysteine, and hemodialysis for massive acetaminophen overdose. Am J Emerg Med. 2020 Mar;38(3):692.e5-692.e7. doi: 10.1016/j.ajem.2019.09.026. Epub 2019 Nov 18. PMID: 31785980.
Akakpo JY, Ramachandran A, Kandel SE, Ni HM, Kumer SC, Rumack BH, Jaeschke H. 4-Methylpyrazole protects against acetaminophen hepatotoxicity in mice and in primary human hepatocytes. Hum Exp Toxicol. 2018 Dec;37(12):1310-1322. doi: 10.1177/0960327118774902. Epub 2018 May 9. PMID: 29739258; PMCID: PMC6482816.
Link SL, Rampon G, Osmon S, Scalzo AJ, Rumack BH. Fomepizole as an adjunct in acetylcysteine treated acetaminophen overdose patients: a case series. Clin Toxicol (Phila). 2021 Oct 28:1-6. doi: 10.1080/15563650.2021.1996591. Epub ahead of print. PMID: 34709101.
Shah KR, Fox C, Geib AJ, Murphy C, Kopec K, Kerns Ii W, Dulaney A, Beuhler MC. Fomepizole as an adjunctive treatment in severe acetaminophen ingestions: a case series. Clin Toxicol (Phila) . 2021 Jan;59(1):71-72. doi: 10.1080/15563650.2020.1775847. Epub 2020 Jun 15. PMID: 32538692.
Kang AM, Padilla-Jones A, Fisher ES, Akakpo JY, Jaeschke H, Rumack BH, Gerkin RD, Curry SC. The Effect of 4-Methylpyrazole on Oxidative Metabolism of Acetaminophen in Human Volunteers. J Med Toxicol. 2020 Apr;16(2):169-176. doi: 10.1007/s13181-019-00740-z. Epub 2019 Nov 25. PMID: 31768936; PMCID: PMC7099124.
Akakpo JY, Ramachandran A, Duan L, Schaich MA, Jaeschke MW, Freudenthal BD, Ding WX, Rumack BH, Jaeschke H. Delayed Treatment With 4-Methylpyrazole Protects Against Acetaminophen Hepatotoxicity in Mice by Inhibition of c-Jun n-Terminal Kinase. Toxicol Sci. 2019 Jul 1;170(1):57-68. doi: 10.1093/toxsci/kfz077. PMID: 30903181; PMCID: PMC6592188.
Yip L, Heard K. Potential adjunct treatment for high-risk acetaminophen overdose. Clin Toxicol (Phila). 2016 Jun;54(5):459. doi: 10.3109/15563650.2016.1144889. Epub 2016 Feb 26. PMID: 26919296.
Chiu MH, Jaworska N, Li NL, Yarema M. Massive Acetaminophen Overdose Treated Successfully with N-Acetylcysteine, Fomepizole, and Hemodialysis. Case Rep Crit Care . 2021 Jul 11;2021:6695967. doi: 10.1155/2021/6695967. PMID: 34336301; PMCID: PMC8289598.
Cuninghame S, Lotfy K, Cameron P. Massive acetaminophen overdose with metabolic acidosis refractory to N -acetylcysteine, fomepizole, and renal replacement therapy. Toxicol Rep. 2021 Apr 6;8:804-807. doi: 10.1016/j.toxrep.2021.03.031. PMID: 33868959; PMCID: PMC8044808.
Akakpo JY, Jaeschke MW, Ramachandran A, Curry SC, Rumack BH, Jaeschke H. Delayed administration of N-acetylcysteine blunts recovery after an acetaminophen overdose unlike 4-methylpyrazole. Arch Toxicol. 2021 Oct;95(10):3377-3391. doi: 10.1007/s00204-021-03142-9. Epub 2021 Aug 22. PMID: 34420083; PMCID: PMC8448936.
Mehrpour O, Saeedi F, Hadianfar A, Mégarbane B, Hoyte C. Prognostic factors of acetaminophen exposure in the United States: An analysis of 39,000 patients. Hum Exp Toxicol. 2021 Nov 12:9603271211061503. doi: 10.1177/09603271211061503. Epub ahead of print. PMID: 34772307.
Review Articles
Green JL, Heard KJ, Reynolds KM, Albert D. Oral and Intravenous Acetylcysteine for Treatment of Acetaminophen Toxicity: A Systematic Review and Meta-analysis. West J Emerg Med. 2013 May;14(3):218-26. doi: 10.5811/westjem.2012.4.6885. PMID: 23687539; PMCID: PMC3656701.
Wax P.M. (2015). Antidotes in depth. Hoffman R.S., & Howland M, & Lewin N.A., & Nelson L.S., & Goldfrank L.R.(Eds.), Goldfrank’s Toxicologic Emergencies, 10e. McGraw Hill. https://accessemergencymedicine.mhmedical.com/content.aspx?bookid=1163§ionid=65087072
Schult, R.F., & Acquisto, N.M. (2018). Acetaminophen and Salicylates. https://www.semanticscholar.org/paper/Acetaminophen-and-Salicylates-Schult-Acquisto/b83d71a8d86c2ae314f7ada05c87754e19ec5162
Kanter MZ. Comparison of oral and i.v. acetylcysteine in the treatment of acetaminophen poisoning. Am J Health Syst Pharm. 2006 Oct 1;63(19):1821-7. doi: 10.2146/ajhp060050. PMID: 16990628.
Rushworth GF, Megson IL. Existing and potential therapeutic uses for N-acetylcysteine: the need for conversion to intracellular glutathione for antioxidant benefits. Pharmacol Ther. 2014 Feb;141(2):150-9. doi: 10.1016/j.pharmthera.2013.09.006. Epub 2013 Sep 28. PMID: 24080471.
Akakpo JY, Ramachandran A, Jaeschke H. Novel strategies for the treatment of acetaminophen hepatotoxicity. Expert Opin Drug Metab Toxicol. 2020 Nov;16(11):1039-1050. doi: 10.1080/17425255.2020.1817896. Epub 2020 Sep 14. PMID: 32862728; PMCID: PMC7606761.
Yan M, Huo Y, Yin S, Hu H. Mechanisms of acetaminophen-induced liver injury and its implications for therapeutic interventions. Redox Biol. 2018 Jul;17:274-283. doi: 10.1016/j.redox.2018.04.019. Epub 2018 Apr 22. PMID: 29753208; PMCID: PMC6006912.
Fisher ES, Curry SC. Evaluation and treatment of acetaminophen toxicity. Adv Pharmacol. 2019;85:263-272. doi: 10.1016/bs.apha.2018.12.004. Epub 2019 Jan 22. PMID: 31307590.
Millea PJ. N-acetylcysteine: multiple clinical applications. Am Fam Physician. 2009 Aug 1;80(3):265-9. PMID: 19621836.
Hendrickson RG. What is the most appropriate dose of N -acetylcysteine after massive acetaminophen overdose? Clin Toxicol (Phila). 2019 Aug;57(8):686-691. doi: 10.1080/15563650.2019.1579914. Epub 2019 Feb 19. PMID: 30777470.
Marzullo L. An update of N-acetylcysteine treatment for acute acetaminophen toxicity in children. Curr Opin Pediatr. 2005 Apr;17(2):239-45. doi: 10.1097/01.mop.0000152622.05168.9e. PMID: 15800420.
Rumack BH, Bateman DN. Acetaminophen and acetylcysteine dose and duration: past, present and future. Clin Toxicol (Phila). 2012 Feb;50(2):91-8. doi: 10.3109/15563650.2012.659252. Erratum in: Clin Toxicol (Phila). 2021 Apr;59(4):359. Erratum in: Clin Toxicol (Phila). 2021 May 14;:1. PMID: 22320209.
Rumack BH. Acetaminophen overdose. Am J Med. 1983 Nov 14;75(5A):104-12. doi: 10.1016/0002-9343(83)90240-1. PMID: 6359859.
Heard K, Green J. Acetylcysteine therapy for acetaminophen poisoning. Curr Pharm Biotechnol. 2012 Aug;13(10):1917-23. doi: 10.2174/138920112802273146. PMID: 22352734.
Klein-Schwartz W, Doyon S. Intravenous acetylcysteine for the treatment of acetaminophen overdose. Expert Opin Pharmacother. 2011 Jan;12(1):119-30. doi: 10.1517/14656566.2011.537261. Epub 2010 Dec 2. PMID: 21126198.
Zed PJ, Krenzelok EP. Treatment of acetaminophen overdose. Am J Health Syst Pharm. 1999 Jun 1;56(11):1081-91; quiz 1091-3. doi: 10.1093/ajhp/56.11.1081. PMID: 10385455.
Brok J, Buckley N, Gluud C. Interventions for paracetamol (acetaminophen) overdose. Cochrane Database Syst Rev. 2006 Apr 19;(2):CD003328. doi: 10.1002/14651858.CD003328.pub2. Update in: Cochrane Database Syst Rev. 2018 Feb 23;2:CD003328. PMID: 16625578.
Woodhead K, Foex BA. BET 1: In paracetamol overdose, is oral N-acetylcysteine as effective as intravenous N-acetylcysteine? Emerg Med J. 2018 Oct;35(10):643-645. doi: 10.1136/emermed-2018-208093.2. PMID: 30249712.
Koppen A, van Riel A, de Vries I, Meulenbelt J. Recommendations for the paracetamol treatment nomogram and side effects of N-acetylcysteine. Neth J Med. 2014 Jun;72(5):251-7. PMID: 24930458.
Waring WS. Novel acetylcysteine regimens for treatment of paracetamol overdose. Ther Adv Drug Saf. 2012 Dec;3(6):305-15. doi: 10.1177/2042098612464265. PMID: 25083244; PMCID: PMC4110842.
Lewis RK, Paloucek FP. Assessment and treatment of acetaminophen overdose. Clin Pharm. 1991 Oct;10(10):765-74. PMID: 1683827.
Fontana RJ. Acute liver failure including acetaminophen overdose. Med Clin North Am. 2008 Jul;92(4):761-94, viii. doi: 10.1016/j.mcna.2008.03.005. PMID: 18570942; PMCID: PMC2504411.
Salgia AD, Kosnik SD. When acetaminophen use becomes toxic. Treating acute accidental and intentional overdose. Postgrad Med. 1999 Apr;105(4):81-4, 87, 90. doi: 10.3810/pgm.1999.04.673. PMID: 10223088.
Chowdhury A, Nabila J, Adelusi Temitope I, Wang S. Current etiological comprehension and therapeutic targets of acetaminophen-induced hepatotoxicity. Pharmacol Res. 2020 Nov;161:105102. doi: 10.1016/j.phrs.2020.105102. Epub 2020 Jul 30. PMID: 32738495.
Burnham K, Yang T, Smith H, Knight S. A review of alternative intravenous acetylcysteine regimens for acetaminophen overdose. Expert Rev Clin Pharmacol. 2021 Oct;14(10):1267-1278. doi: 10.1080/17512433.2021.1946392. Epub 2021 Jun 30. PMID: 34187297.
Brok J, Buckley N, Gluud C. Interventions for paracetamol (acetaminophen) overdoses. Cochrane Database Syst Rev. 2002;(3):CD003328. doi: 10.1002/14651858.CD003328. Update in: Cochrane Database Syst Rev. 2006;(2):CD003328. PMID: 12137690.
Blackford MG, Felter T, Gothard MD, Reed MD. Assessment of the clinical use of intravenous and oral N-acetylcysteine in the treatment of acute acetaminophen poisoning in children: a retrospective review. Clin Ther. 2011 Sep;33(9):1322-30. doi: 10.1016/j.clinthera.2011.08.005. Epub 2011 Sep 3. PMID: 21890206.
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Mullins ME, Yeager LH, Freeman WE. Metabolic and mitochondrial treatments for severe paracetamol poisoning: a systematic review. Clin Toxicol (Phila). 2020 Dec;58(12):1284-1296. doi: 10.1080/15563650.2020.1798979. Epub 2020 Aug 7. PMID: 32762579.
Wright RO, Perry HE, Woolf AD, Shannon MW. Hemolysis after acetaminophen overdose in a patient with glucose-6-phosphate dehydrogenase deficiency. J Toxicol Clin Toxicol. 1996;34(6):731-4. doi: 10.3109/15563659609013837. PMID: 8941205.
Waring WS. Criteria for acetylcysteine treatment and clinical outcomes after paracetamol poisoning. Expert Rev Clin Pharmacol. 2012 May;5(3):311-8. doi: 10.1586/ecp.12.15. PMID: 22697593.
Rolff HC, Christensen HR, Dalhoff K. Intravenøs eller oral N-acetylcysteinbehandling til paracetamolforgiftede patienter. Er det tid til at revurdere behandlingsinstruksen? [Intravenous or oral N acetylcysteine therapy in paracetamol poisoned patients. Should treatment guidelines be reviewed?]. Ugeskr Laeger. 2010 Mar 29;172(13):1020-4. Danish. PMID: 20350475.
Ash SR, Caldwell CA, Singer GG, Lowell JA, Howard TK, Rustgi VK. Treatment of acetaminophen-induced hepatitis and fulminant hepatic failure with extracorporeal sorbent-based devices. Adv Ren Replace Ther. 2002 Jan;9(1):42-53. doi: 10.1053/jarr.2002.30473. PMID: 11927906.
Kociancic T, Reed MD. Acetaminophen intoxication and length of treatment: how long is long enough? Pharmacotherapy. 2003 Aug;23(8):1052-9. doi: 10.1592/phco.23.8.1052.32884. PMID: 12921251.
Sztajnkrycer MJ, Bond GR. Chronic acetaminophen overdosing in children: risk assessment and management. Curr Opin Pediatr. 2001 Apr;13(2):177-82. doi: 10.1097/00008480-200104000-00016. PMID: 11317062.
Janes J, Routledge PA. Recent developments in the management of paracetamol (acetaminophen) poisoning. Drug Saf. 1992 May-Jun;7(3):170-7. doi: 10.2165/00002018-199207030-00002. PMID: 1503665.
Bryczkowski C, Geib AJ. Combined butalbital/acetaminophen/caffeine overdose: case files of the Robert Wood Johnson Medical School Toxicology Service. J Med Toxicol. 2012 Dec;8(4):424-31. doi: 10.1007/s13181-012-0261-z. PMID: 23011802; PMCID: PMC3550265.
Gosselin S, Juurlink DN, Kielstein JT, Ghannoum M, Lavergne V, Nolin TD, Hoffman RS; Extrip Workgroup. Extracorporeal treatment for acetaminophen poisoning: recommendations from the EXTRIP workgroup. Clin Toxicol (Phila). 2014 Sep-Oct;52(8):856-67. doi: 10.3109/15563650.2014.946994. Epub 2014 Aug 18. PMID: 25133498.
Alsalim W, Fadel M. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Oral methionine compared with intravenous n-acetyl cysteine for paracetamol overdose. Emerg Med J. 2003 Jul;20(4):366-7. doi: 10.1136/emj.20.4.366. PMID: 12835357; PMCID: PMC1726135.
van Berge Henegouwen GP, Savelkoul TJ. Acetylcysteïne bij paracetamoloverdosering; intraveneuze maar ook orale therapie is zinvol, ook bij late toepassing [Acetylcysteine in paracetamol overdose; intravenous but also oral therapy is helpful even in late application] . Ned Tijdschr Geneeskd. 1994 Oct 1;138(40):1988-92. Dutch. PMID: 7935954.
Huang JW, Lahey B, Clarkin OJ, Kong J, Clark E, Kanji S, McCudden C, Akbari A, J W Chow B, Shabana W, Hiremath S. A Systematic Review of the Effect of N-Acetylcysteine on Serum Creatinine and Cystatin C Measurements. Kidney Int Rep. 2020 Dec 3;6(2):396-403. doi: 10.1016/j.ekir.2020.11.018. PMID: 33615065; PMCID: PMC7879108.
Delanty N, Fitzgerald DJ. Paracetamol poisoning: the action line and the timing of acetylcysteine therapy. Ir Med J. 1996 Sep-Oct;89(5):156, 158. PMID: 8936831.
Jaeschke H, Akakpo JY, Umbaugh DS, Ramachandran A. Novel Therapeutic Approaches Against Acetaminophen-induced Liver Injury and Acute Liver Failure. Toxicol Sci. 2020 Apr 1;174(2):159-167. doi: 10.1093/toxsci/kfaa002. PMID: 31926003; PMCID: PMC7098369.
Akakpo JY, Ramachandran A, Orhan H, Curry SC, Rumack BH, Jaeschke H. 4-methylpyrazole protects against acetaminophen-induced acute kidney injury. Toxicol Appl Pharmacol. 2020 Dec 15;409:115317. doi: 10.1016/j.taap.2020.115317. Epub 2020 Nov 4. PMID: 33157119; PMCID: PMC7888547.
Podcasts & Medical Blogs
Rabbit Hole: Acetaminophen Toxicology/ Overdose
