Interpretation
| Result | Meaning |
|---|---|
| Criteria met | High mortality without transplant: refer/list |
| Not met | Does not exclude poor outcome; reassess serially |
Formula
Acetaminophen: pH <7.30 OR (INR >6.5 AND creatinine >3.4 mg/dL [300 µmol/L] AND grade III/IV encephalopathy). Non-acetaminophen: INR >6.5 OR ≥3 of: age <10 or >40; non-A non-B hepatitis, halothane or idiosyncratic drug reaction; jaundice → encephalopathy >7 days; INR >3.5; bilirubin >17.5 mg/dL (300 µmol/L).
Clinical pearls
- The original paper used prothrombin time (>100 s; >50 s for the minor criterion); INR >6.5 and >3.5 are the conventional equivalents.
- High specificity but modest sensitivity: not meeting criteria does not mean the patient will survive. Bernal (2002) added arterial lactate >3.5 mmol/L at 4 h or >3.0 after resuscitation for acetaminophen ALF.
- Refer early to a transplant centre; do not wait for criteria to be met.
Examples
king's college criteria acetaminophen overdose pH 7.25kings college non-acetaminophen 45 yo seronegative hepatitis, jaundice 10 days before encephalopathy, INR 3.0, bili 20does this tylenol overdose need transplant: INR 7, creatinine 3.6, grade 3 encephalopathy, pH 7.35
FAQ
What are the King's College criteria for acetaminophen overdose?
Arterial pH below 7.30 after fluid resuscitation, or all three of INR >6.5, creatinine >3.4 mg/dL and grade III–IV encephalopathy within 24 hours.
Are the King's College criteria sensitive?
No. They are highly specific for death without transplant but miss a meaningful share of patients who die, so serial reassessment and early referral matter.