Acute APAP Poisoning

Phase 1 (up to 24 hours): Asymptomatic or nonspecific symptoms, anorexia, malaise, nausea, vomiting, pallor, diaphoresis. Phase 2 (24-72 hours): Onset of hepatic injury, right upper quadrant (RUQ) pain, high aspar-tate aminotransferase (AST), then increased prothrombin time (PT) and alanine amino-transferase (ALT).

Phase 3 (72-96 hours): Hepatic necrosis, coag-ulopathy, jaundice, encephalopathy, coma, all LFTs high, renal failure (25%), ARDS and pancreatitis possible.

Phase 4 (4 days-2 weeks): Recovery, complete hepatic regeneration in survivors.

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