Acetaminophen toxicity can cause liver damage and failure if too much is ingested. It is metabolized in the liver and toxic metabolites can accumulate if pathways are saturated from overdose. Treatment involves assessing risk using a nomogram plotting acetaminophen levels drawn 4 hours after ingestion. N-acetylcysteine is given if above the risk line to replenish glutathione and prevent toxicity. It is administered orally or intravenously in a multi-dose regimen over days. Outcomes depend on prompt treatment to prevent liver failure and possible need for transplant.