Paracetamol overdose is common. If left untreated, liver and/or renal failure can develop. Administration of the antidote, acetylcysteine, within 8–10 hours of overdose minimizes or prevents liver damage. After overdose, the tests used to identify that patients are at risk of liver injury are well established but have limitations. Once liver injury has occurred, important prognostic factors are the presence of hepatic encephalopathy, the international normalized ratio, acid–base status and renal function.