EPIDEMIOLOGY Acetaminophen is widely available, and lay people

commonly underestimate its toxicity. Not surprisingly, acetaminophen

accounts for more overdoses and overdose deaths each year in the
United States than any other pharmaceutical agent [8]. More than
1200 cases of severe hepatic injury and 21 deaths were attributed to
acetaminophen intoxication during 2003, accounting for 23 percent of
all pharmaceutical-related deaths reported that year [8].
A national network established to track cases of acute liver failure in
the United States found that nearly half the episodes are attributable
toacetaminophen, and such cases appear to be increasing as a
percentage of all acute liver failure events [9,13]. Data from this group
demonstrate that intentional (suicidal) and unintentional (chronic)
poisonings account equally for cases of acetaminophen-associated
hepatic failure [9].
A retrospective review of all cases of acetaminophen overdose that
occurred over ten years in the Calgary region of Canada noted the
following:

Of 1543 patients, 70 (4.5 percent) developed

hepatotoxicity and 15 died during their initial hospital admission.

Risk factors for hepatotoxicity included unintentional

overdose (OR 5.18; 95% CI 3.00-8.95), alcohol abuse (OR 2.21;
95% CI 1.30-3.76), and underlying liver disease (OR 3.50; 95%
CI 1.57-7.77).