@Mman DILI Network is a great resource (best we have for sure: dilin.org). But it’s really rare for someone to get over 7500mg of APAP unintentionally even when they double up their Tylenol and Percocet (that happens all the time). We get a Tylenol overdose on service every few weeks and I can’t remember the last unintentional one that didn’t do fine with a little NAC. It’s the most common cause but not even close to antibiotics when you remove the intentional overdoses. Plus NAC doesnt help the idiosyncratic reactions (still given but much less evidence). He may have been PCN allergic, gotten something other than ancef for that. I’ve been surprised what patients received many times. The time course really argues for a drug given in the hospital.
Also, it kinda stops being 1:1,000,000 when you start with a population who all have ALF from something.
@Blockit EtOH and APAP is an interesting topic. Chronic use is bad but acute use is protective against APAP overdose. But EtOH doesn’t do anything this fast on its own and he’s probably too young to be cirrhotic from EtOH. My personal record is mid-20s.