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Acute liver injury (ALI) caused by intentional acetaminophen overdose is well known; however, ALI caused by therapeutic dosing is less-well defined. To explore this phenomenon, researchers prospectively reviewed all patients with severe ALI who were admitted to one French hospital from 2002 through 2019. Patients with cirrhosis were excluded. The authors identified 89 patients with severe ALI after acetaminophen intake at therapeutic doses (defined by the authors as <6 g/day). The median maximum daily dose was 4 g daily, and 40% of patients took less than 3 g daily. Median duration of intake was 4 days.
All cases of ALI from therapeutic acetaminophen doses were associated with either heavy drinking or fasting (i.e., ≥24 hours without food pr…