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This study, done out of Australia, examined the association between abdominal pain and severity of liver injury in patients presenting after acute acetaminophen overdose.
539 cases were identified where N-acetylcysteine was administered to patients with acetaminophen overdose. The investigators explored parameters including presence of abdominal pain, time post-ingestion, and peak ALT.
Patients less than 8 hours post overdose WITH abdominal pain were as likely to develop hepatotoxicity as those presenting WITHOUT abdominal pain. (OR=1.18 [0.07 to 19.4])
Patients presenting 8 or more hours post overdose WITH abdominal pain were as likely to develop hepatotoxicity as those WITHOUT abdominal pain (OR=1.28 [0.39 to 4.21])
Don't let lack of pain fool you! Just as we all learned in medical school - let your history be your guide!
References
Wang C, Wong A. The presence of abdominal pain associated with acetaminophen overdose does not predict severity of liver injury. Am J Emerg Med. 2024;79:52-57. doi:10.1016/j.ajem.2024.02.011