Utility of acetaminophen screening in unsuspected suicidal ingestions

Acetaminophen (APAP) is a common overdosed medication. Because of the lack of specific symptoms associated with initial toxicity, potential unsuspected APAP toxicity is a concern in suicidal ingestions. To identify the likelihood of unsuspected APAP toxicity in suicidal ingestions, we performed a retrospective study of all suicidal ingestions without a history of APAP exposure reported to a poison control center over a 6-mo period. History, symptoms, and APAP levels to assessed the incidence of unsuspected APAP ingestions. In a total of 471 cases, 151 had APAP levels requested but not documented in our records. Of the remaining 320 cases, 23 (7.2%) had APAP levels > 10 microg/mL. Twelve patients were treated with Nacetylcysteine, 7 patients (2.2 %) had potentially toxic levels, and 5 patients had non-toxic or uninterpretable levels. Although the overall risk of unsuspected acetaminophen toxicity in suicidal ingestions is small, the definite risk in this treatable entity warrants universal APAP screening in all suicidal ingestions.