Objective: To determine the scientific evidences of accidental overdose with acetaminophen that caused acute liver failure in patients and the causes of the overdose. Method: Bibliographic search of original research studies, published from January of 2010 to November of 2018. Results: Of the patients that developed acute liver failure due to accidental overdose with acetaminophen, the great majority were polymedicated with opiates; patients that seeked to calm the pain, thus a poor supervision of the treatment by the prescribing doctors and the pharmacists, gave place to self-medication, duplicity, and overdose. In children, younger than 18 years of age, the principal cause was produced by mistakes of the caregivers: confusion in the alternating pattern with ibuprofen, due to confusion of the dose and correct guideline of age and weight. Conclusion: Cases of hepatotoxicity and acute liver failure exist due to accidental overdose with acetaminophen, being the main causes those produced by the health system: poor management and supervision of treatment by medical centers and pharmacies. Patient medication knowledge: on the part of the patients, the perception of "innocuous" is alarming, regardless of the dose, understood as the absence of toxicity.