Acetaminophen. Concepts and controversies

APAP poisoning is common, and despite the availability of a specific antidote, fatalities still occur. Early treatment using NAC is highly effective in preventing liver injury, but further study is needed to determine optimum indications, route of administration, dosage, and duration of treatment. Recent advances have changed traditional concepts regarding late treatment and mechanisms of NAC action, but significant gaps in understanding persist. Immediate challenges include refining the diagnosis and treatment of APAP toxicity after repeated ingestions, defining settings in which deviation from standard protocols is appropriate, and improving therapy of APAP-induced hepatic failure.