ABSTRACT Background: Acute paracetamol toxicity is one of the commonest toxicities that lead to serious hepatic injury that could propagate to fulminant hepatic failure. An increase in serum level of alpha fetoprotein was observed following liver injury, and this increase was assumed to be associated with hepatic regeneration. Alpha fetoprotein (AFP) ratio (day 3/day 1 serum level) was proved to be a predictor for prognosis. Aim: The present study aims to evaluate the prognostic value of serum AFP and to evaluate the value of alpha fetoprotein ratio (day 2/day 1 serum level) for earlier prediction of the degree of liver regeneration after acute paracetamol toxicity. Methods: The present study was conducted on 32 patients with acute single paracetamol overdose admitted to the Poison Control Centre of Ain Shams University hospitals (PCC-ASUH). Liver routine laboratory tests were done on admission and on the second day in addition to measurement of the serum level of alpha fetoprotein. Results and Conclusions: Results showed that the increased serum level of alpha fetoprotein was linked to regeneration of the liver which was suggested by shortening of the duration of hospital stay. In addition, the AFP ratio day2/day1 serum level was suggested by the study results to be an efficient prognostic factor in cases with acute paracetamol toxicity for early prediction of the state of regeneration of the liver. Key words: Acute paracetamol toxicity, Alpha fetoprotein, Liver regeneration