were retrospectively reviewed at Parkland Hospital in a 40-month period. 71 cases were identified; 50 were suicidal overdoses and 21 were unintentional poisonings. In the suicidal group, the median dose was 24 g and 25% were chronic alcoholics. Due to the early use of N-acetylcysteine, only 3 patients in this group developed acute liver failure with coma and one died. In the accidental group, the median dose was 12 g although three took <4 g; in this group, 63% were chronic alcoholics and 7 of 21 developed acute liver failure with coma and 4 died. Altogether acetaminophen hepatotoxicity accounted for 40% of cases of acute liver failure at Parkland hospital during the interval studied. Since Parkland is not a transplant center, this incidence reflects the community experience rather than a referral bias. This study underscores that accidental acetaminophen poisoning may be the most common cause of acute liver failure in general hospitals. Chronic alcoholics may be at increased risk, although usually more than the recommended doses of acetaminophen are ingested for pain relief.