Intensive Care Medicine

, Volume 40, Issue 6, pp 888–890 | Cite as

Understanding paracetamol-induced liver failure

  • Fin Stolze LarsenEmail author
  • Julia Wendon
Understanding the Disease

Paracetamol (N-acetyl-p-aminophenol) is among the most widely used over-the-counter antipyretic and analgesic drugs. Paracetamol is generally considered to be safe at recommended therapeutic doses but concerns accumulate worldwide, as it has been recognized as a frequent cause of acute liver failure (ALF).

Toxicity profile

Paracetamol is absorbed from the small intestine with a peak serum concentration within 1–2 h for tablet preparations and within 30 min for liquid preparations. Measured levels do normally not exceed 130 μmol/L but are dependent upon effective gastric emptying. The mechanism of action is not completely understood but is assumed to be related to inhibition of cyclooxygenase and modulation of the endogenous cannabinoid system. Following absorption paracetamol is mainly metabolized in the liver into water-soluble substances by glucuronidation and sulphation that are then excreted in the urine. A smaller fraction (10–15 %) is eliminated by N-hydroxylation by cytochrome...


Paracetamol Hepatic Encephalopathy Lactic Acidosis Acute Liver Failure Bioactivation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Acute liver failure




N-Acetyl-p-benzoquinone imine


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2014

Authors and Affiliations

  1. 1.Department of Hepatology, RigshospitaletUniversity Hospital of CopenhagenCopenhagen ØDenmark
  2. 2.Institute of Liver StudiesKings College HospitalLondonUK

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