Epidemiology

apap

APAP is contained in over 100 over-the counter (OTC) preparations, and fulminant liver failure from APAP overdose is the second most common cause of liver transplantation in the United States (No. 1 cause = hepatitis C). More than 100,000 analgesic overdoses per year, over 200 deaths, 46% due to APAP. APAP overdose hospitalizations are greater than all other overdose hospitalizations. APAP has replaced ASA as the analgesic-antipyretic of choice, especially for children secondary to safety profile, N-acetylcysteine (NAC) antidote, ASA toxicity, and Reye's Syndrome. APAP toxicity risk factors: low hepatic gluta-thione stores in alcoholics and malnourished; P450 enzyme induction from INH, rifampin, anticonvulsants, and chronic alcohol abuse.

Methyl salicylate (oil of wintergreen): 530 mg ASA/mL; 8 mL = 13,325 mg ASA tablets. As little as 4 mL of methyl salicylate can be lethal in children.

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