Uncertain timing of reported acetaminophen ingestion in an adolescent analgesic overdose: a case report

A 16-year-old male presented after reported ingestion of acetaminophen and multiple NSAIDs for dental pain. Although he reported taking acetaminophen 6,000 mg, his concentration was 22.3 mg/L approximately 19 h after the first reported ingestion, higher than expected from the reported dose and timing. Aminotransferases were normal, indicating no acetaminophen-induced liver injury at presentation. N-acetylcysteine was initiated because the concentration was clinically relevant in the setting of uncertain or staggered ingestion, and recovery was uneventful. This case highlights the importance of prioritizing measured acetaminophen concentrations and laboratory assessment over reported dose alone.