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King's College Criteria for acetaminophen toxicity
Identifies acetaminophen liver failure likely to need transplant.
King's College Criteria for acetaminophen toxicity
Arterial pH (after fluid resuscitation)
pH
INR (or PT in seconds via labs)
INR
Serum creatinine
mg/dL
Grade III or IV hepatic encephalopathy
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When to use
- Deciding on liver-transplant referral in acetaminophen-induced acute liver failure.
Formula
Positive if arterial pH <7.30, OR all three of: INR >6.5 (PT >100 s), creatinine >3.4 mg/dL (300 umol/L), and grade III/IV hepatic encephalopathy.
Pearls and pitfalls
- Assess pH after adequate volume resuscitation.
- Creatinine >3.4 mg/dL corresponds to >300 umol/L.
- Meeting criteria has high specificity but limited sensitivity; not meeting them does not exclude a poor outcome.