How do you decide whether to offer acetaminophen to patients with mild and/or resolving acute liver injury?

This is an interesting question, as we often need to turn to something to help with fever or pain, while our inpatients often have a contraindication to NSAIDs, and we typically want to avoid opioids when we can, especially in our liver patients who carry risks of bleeding and encephalopathy.

For ac...

I agree with the guidance listed as long as the initial liver injury was not caused by acetaminophen. I routinely prescribe with a limit of less than 2 g per day and trend LFTs. The alternatives, such as NSAIDs or opioids, can be worse in some patients. Another thing to consider is the use of bupren...