The original NAC infusion regimen described by Prescott in the late 1970s gives rise to very high initial blood concentrations, which are associated with the development of adverse effects a number of alternative regimens have been described, which incorporate a slower initial rate of infusion (Prescott et al. A history of acute or chronic alcohol ingestion and biochemical tests of malnutrition have been explored as means of detecting an increased susceptibility to paracetamol liver toxicity however, none of these are sufficiently reliable for routine clinical application (Waring et al. However, there are difficulties in relying on patient reporting, and errors may occur concerning the reported drug name, dose and timing of ingestion (Zyoud et al. Most prominently, the extent of paracetamol exposure may be estimated from a measured serum concentration at a known interval after ingestion. A number of methods have been applied in clinical practice for risk stratification, such that NAC is administered to patients thought to be at significant risk of paracetamol-induced liver injury. However, NAC is associated with a number of adverse effects, including nausea, vomiting and non-immunoglobulin E anaphylactic (anaphylactoid) reactions (Zyoud et al. N-acetylcysteine (NAC) is a well-established antidote for a paracetamol (acetaminophen) overdose and is highly effective in minimising liver injury if administered promptly. Research published in high-impact journals and from high income countries is most likely to be cited in published paracetamol research. Interest in paracetamol poisoning as a serious clinical problem continues to grow. This study is the first bibliometric assessment of the top 100 cited articles in toxicology literature. The USA had the largest number of articles, 47, followed by the UK and Australia with 38 and nine articles respectively. In relation to the origin of the research publications, they were from 8 countries. Citations per year since publication for the top 100 most-cited articles ranged from 1.5 to 42.6 and had a mean of 8.5 citations per year and a median of 5.9 with an interquartile range of 3.75–10.35. Nine documents were published in Clinical Toxicology, whereas eight documents were published in Annals of Emergency Medicine. A total of 55 journals published these 100 most cited articles. A significant, modest positive correlation was found between years since publication and the number of citations among the top 100 cited articles (r = 0.316 p = 0.001). The average number of years since publication was 17.6 years, and 45 of the publications were from the 2000s. These publications were published between 19. The median number of citations was 75 (interquartile range 56–137). All eligible articles were read for basic information, including total number of citations, average citations per year, authors’ names, journal name, impact factors, document types and countries of authors of publications. The 100 most highly cited articles in paracetamol poisoning treatment were identified from the Scopus database in November 2015. The current study was performed to recognize and describe the most highly cited articles related to paracetamol poisoning treatment. Analysis of the most influential publications within paracetamol poisoning treatment can be helpful in recognizing main and novel treatment issues within the field of toxicology.

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