Reply:

We appreciate the comments of Drs. Craig and Simpson and Drs. Mullins and Schwartz, and the challenge they raise to make MALD more believable, comprehensible, and usable. Acetaminophen (APAP) toxicity is indeed a complex process involving multiple steps. Although the underlying mathematics is more involved than the statistical regression models with which physicians are more familiar, MALD could easily be reduced to a web-based or hand-held format for bedside use. The mathematical model accurately fits patient data from the University of Utah. If the modeling holds up in a prospective cohort, we will certainly convert MALD to a more user-friendly format.