To the Editor: The suggestion by Cheung et al. (June 30 issue)1that an acetaminophen overdose in an alcoholic should be treatedwith acetylcysteine regardless of the serum acetaminophen concentrationis unfounded and contrary to the available evidence. The literatureincludes well over 10,000 cases of acetaminophen overdose,2,3and the accumulated experience worldwide must involve well over100,000 cases. Despite this extensive experience, we are unawareof any other bona fide examples of the phenomenon describedby Cheung and colleagues, who reported a case of fatal acetaminophen-inducedhepatic failure in an alcoholic patient despite a "nontoxic"serum acetaminophen concentration.
Lucas, A. M., Hennig, G., Dominick, P. K., Whiteley, H. E., Roberts, J. C., Cohen, S. D.
(2000). Ribose Cysteine Protects Against Acetaminophen-Induced Hepatic and Renal Toxicity. Toxicol Pathol
28: 697-704
[Abstract]
Lee, W. M.
(1995). Drug-Induced Hepatotoxicity. NEJM
333: 1118-1127
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