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However, there are many other patients who intentionally over-ingest APAP (with clear evidence from careful history taking and measured APAP levels), or the more indolent and accidental over-ingestion of doses over 4000 mg per day (not as obvious when eliciting the patient history), which we would like to term “ therapeutic misfortune .” The United States FDA clearly states “severe liver damage may occur if you take more than 4000 mg of acetaminophen in 24 hours.” 31 In these extreme circumstances, prompt medical assessment and therapeutic intervention is necessary to administer therapy that will allow for salvage of a damaged and/or failing liver

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10.1016/j.ajhg.2011.08.011 Am