The data obtained from this study will provide the framework for understanding the role of inflammation in the mediation of acetaminophen toxicity in man. Time profiles for inflammatory mediators and correlations between hepatoxicity and the presence of nitrotyrosine and cytokines in plasma will be generated. This data is a prerequisite for the development of new therapies that would inhibit the formation of key inflammatory mediators in acetaminophen toxicity. Of particular interest is the development of therapies that would be effective beyond the timepoint for which NAC is traditionally thought to be of greatest benefit. Patients who would benefit from such therapies include children who are victims of chronic acetaminophen poisoning with therapeutic intent, and patients who present late (i.e., greater than 16 hours after acetaminophen overdose) for medical evaluation following acetaminophen overdose. By understanding the role of inflammatory processes in the development of toxicity, novel therapies may be developed that will improve the management and survival of the complicated acetaminophen overdose patient.

Blood samples will be obtained from study patients for the analysis of inflammatory cytokines and nitrotyrosine. Blood samples will be obtained at the time of blood sampling for the routine clinical management of the APAP overdose patient. Patients who are hospitalized will have study blood samples drawn at the time daily blood samples are obtained. The sampling will continue daily until the patient is discharged. In addition to blood sampling the following data will be collected: age, gender, race, circumstances of the ingestion, dose of the ingestion, treatment for the ingestion, concomitant therapy, medical history and cigarette use.