Stage | Hours after ingestion | Clinical features |
I | 0.5 to 24 hours | Nausea, vomiting, diaphoresis, pallor, lethargy, and malaise |
Some patients remain asymptomatic | ||
Laboratory studies are typically normal | ||
II | 24 to 72 hours | Stage I symptoms resolve |
Hepatotoxicity and nephrotoxicity become evident | ||
Right upper quadrant pain, liver enlargement and tenderness | ||
Elevation of aminotransferases occurs within 36 hours of ingestion in patients with hepatic injury | ||
Elevation of prothrombin time (PT) and internationalized ratio of PT | ||
Oliguria, abnormalities of renal function | ||
Elevation of serum amylase with or without clinical pancreatitis may occur | ||
III | 72 to 96 hours | Liver enzyme and function abnormalities peak (enzymes may be >10,000 IU/L) |
Recurrence of Stage I symptoms | ||
Jaundice, hepatic encephalopathy, hyperammonemia, bleeding diathesis, hypoglycemia, lactic acidosis | ||
Renal failure, the incidence of which is related to the severity of intoxication | ||
Death, from multi-organ failure, occurs most commonly in this stage | ||
IV | 4 to 14 days | Recovery phase |
Symptoms and laboratory values may not normalize for several weeks | ||
Histologic recovery lags behind clinical recovery and may take up to three months |
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