Acetaminophen toxicity presents initially with nausea, vomiting, and malaise. Liver inflammation develops resulting in RUQ tenderness and hypotension, followed by signs of liver failure (jaundice, encephalopathy, ascites) and resulting multi-organ failure. The primary treatment for acetaminophen toxicity is N-acetylcysteine (NAC), which acts by direct detoxification and by replenishing stores of glutathione, an important free radical scavenger. Activated charcoal is also part of the recommended treatment for acetaminophen toxicity. However, it is most effective if given within four hours of taking the overdose, after which it quickly loses efficacy. Hemodialysis is indicated for patients who develop acute renal failure from the toxicity and liver failure but is not central to the management of acetaminophen overdose. Alkalization of the blood and urine is effective in salicylate toxicity and overdoses of other acidic drugs, by trapping the acidic toxin and shunting it away from the brain or other organs.