Either there is full resolution of hepatotoxicity or fulminant liver failure progresses to multiorgan failure and death. Stage 4 (>96 hours): Survival or death. Taking more than the recommended amount of acetaminophen. Liver function tests peak, and clinical signs and symptoms of liver failure are evident, including jaundice, vomiting and gastrointestinal pain, coagulopathy, encephalopathy, metabolic acidosis, and possibly acute renal failure and/or pancreatitis. Research has shown that acetaminophen is a major cause of acute liver failure in the United States. Stage 3 (72–96 hours): Hepatic failure with encephalopathy.If injury is severe, then coagulopathy studies (PT, PTT, INR) may increase. AST and ALT begin to rise, and possibly bilirubin. Patients may begin to develop RUQ pain, although sometimes they are clinically asymptomatic. Stage 2 (24–72 hours): Hepatic injury (hepatotoxicity).The vague, nonspecific symptoms of this stage might include nausea and vomiting, diffuse abdominal pain, and general malaise. Stage 1 (0–24 hours): Preclinical toxic effects with minimal signs and symptoms, possibly asymptomatic, and often normal liver function tests.
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