Acute Renal Failure in an Alcoholic Patient Taking Therapeutic Doses of Acetaminophen

Acetaminophen is a popular over-the-counter analgesic used for headaches and minor musculoskeletal pains. Most persons taking therapeutic doses of acetaminophen experience no side effects. taken in greater than the recommended dosage, however, acetaminophen can cause serious complications, including liver and renal failure as well as death. l This outcome is especially evident in those who take acetaminophen with suicidal intent. 2 Although the pathogenesis of acetaminopheninduced hepatotoxicity is well known, the renal effects of acetaminophen have received less attention. Most reports have focused on the renal effects oflarge doses of acetaminophen, usually associated with severe hepatotoxicity or hepatic failure. 3 There are, however, increasing numbers of reports of acetaminophen-associated renal failure in patients who have mild hepatotoxicity (without evidence of liver failure) caused by therapeutic ingestion or overdose. 3 -l 6 Additionally, 4 patients experienced acetaminophen-induced renal failure without any documented liver dysfunction.2.l7.18 If renal failure can occur even with therapeutic doses of acetaminophen, then might there be certain persons predisposed to acetaminophen toxicity?