ReviewInternational journal of legal medicine2026
Paracetamol (acetaminophen) intoxication and basal fatty tubular vacuolisation: a case-control study and review of the literature.
Review in International journal of legal medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Basal fatty tubular vacuolisation (BFTV) of the kidneys has mostly been associated with ketoacidosis. Its occurrence in paracetamol intoxication has not been described. Paracetamol in overdose is hepatotoxic and nephrotoxic but does not cause ketoacidosis. This study aimed at investigating whether BFTV occurs in paracetamol intoxication. The Swedish National Board of Forensic Medicine database was searched for the Uppsala area for 2016-2024 for paracetamol intoxication cases with kidney samples taken. Two equally-sized control groups, matched for age, sex and post-mortem interval, were selected from the same period: other intoxications and hangings. The kidney slides were evaluated by both authors for BFTV according to the scale "none-possible-scant-easily identifiable". The kidney slides were also marked with ten fields and evaluated for the number of fields with BFTV and for the number of fields with formalin pigment deposition. A Kruskal-Wallis test was used to calculate significant differences between the groups. Spearman's rho was used to evaluate associations and a p-value < 0.05 was considered statistically significant. The database search yielded 24 cases. Paracetamol intoxications showed a higher degree of BFTV and more BFTV-positive fields than both control groups (p < 0.05). The number of BFTV-fields correlated with the degree of BFTV and the number of fields with formalin pigment deposition (Spearman's rho 0.691 and 0.544, respectively, p < 0.001). The correlation between the authors' assessments was moderate. Thus, the present study found an association between paracetamol intoxication and BFTV. This likely represents a renal stress reaction due to paracetamol toxicity and not ketoacidosis.
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