Consider discharge for asymptomatic patients who do not require NAC
Admission if requiring NAC or other ingestions, injuries
Transfer to transplant center based on above criteria
Psych consult if patient has suicidal ideation
In subacute toxicity, AST/ALT ratio of < 0.4 has sen of 99% for resolving hepatic injury
Criteria for predicting fulminant hepatic failure, and thus referral to transplant center
PPV 70-90% and sensitivity 69%
Includes:
pH<7.3 or lactate>3 at 12hrs after full fluid resuscitation, OR all of the following:
Cr>3.4
INR>6.5
grade 3 or 4 Hepatic Encephalopathy
pH<7.3 or lactate>3 at 12hrs after full fluid resuscitation, OR all of the following:
Cr>3.4
INR>6.5
grade 3 or 4 Hepatic Encephalopathy
Other predictors of APAP-induced hepatic failure include:
lactate >3.5 4hrs after fluid resusciation
phos >3.8 at 48hrs, OR
APACHE II >15
lactate >3.5 4hrs after fluid resusciation
phos >3.8 at 48hrs, OR
APACHE II >15
Acetaminophen toxicity
Acetaminophen toxicity 
Mescaline toxicity
Viral hepatitis
Cocaine toxicity
Hepatitis A
Carbamate toxicity
Hepatitis B