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    Acetaminophen Toxicity

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    Acetaminophen Toxicity. EM or emergency management and algorithm on how to apply therapeutic intervention on patients with limited time

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    Acetaminophen Toxicity

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    trialqw
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    Acetaminophen Toxicity. EM or emergency management and algorithm on how to apply therapeutic intervention on patients with limited time

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    Acetaminophen Toxicity. EM or emergency management and algorithm on how to apply therapeutic intervention on patients with limited time

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    64 views1 page

    Acetaminophen Toxicity

    Uploaded by

    trialqw
    Acetaminophen Toxicity. EM or emergency management and algorithm on how to apply therapeutic intervention on patients with limited time

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    Acetaminophen Toxicity

    Larson AM. Acetaminophen hepatotoxicity. Clin Liver Dis. 2007;11(3):525-48, vi.


    Pharmacology: Acetaminophen is metabolized through cytochrome P450 system to
    form toxic NAPQI metabolite, which requires glutathione to detoxify.
    Clinical stages of acetaminophen overdose:
    Stage 1 (<24 hr): Abd pain, N/V, anorexia, lethargy, diaphoresis; normal labs
    Stage 2 (24-72 hr): RUQ abdominal pain, jaundice, rising AST/ ALT/INR values
    Stage 3 (72-96 hr): Peak hepatotoxicity, renal insufficiency, and death vs. mild
    symptoms if treated
    Stage 4 (4 days-2 wk): 70% survive acute liver failure; resolution of symptoms
    Toxic ingestion dose: 150 mg/kg
    Lab: Draw serum acetaminophen level at 4 hours post-ingestion.
    Treatment:
    1. Activated charcoal
    - Of benefit <1 hour of ingestion and possible benefit beyond 1 hour
    2. N-acetylcysteine (PO or IV) - Precursor to glutathione
    - Start within 8-10 hours if:
    Above possible hepatic toxicity line
    Estimated single ingestion of acetaminophen >150 mg/kg
    Time of ingestion unknown and serum level > 10 mcg/mL
    Lab evidence of hepatotoxicity and history of excessive ingestion
    Repeated ingestion and a serum level >10 mcg/mL
    - PO: 140 mg/kg first dose and then 70 mg/kg every 4 hours. Typically treat for
    20 hours for uncomplicated overdose.
    - IV: 150 mg/kg first dose over 1 hour, then 50 mg/kg for first 4 hours, then
    100 mg/kg over next 16 hours (total dose = 300 mg/kg over 20 hours)
    Rumack Matthew Nomogram
    Use for single time-point ingestion only. Does not predict toxicity in chronic ingestion.

    Possible hepatic toxicity line is 25% lower than probable hepatic toxicity to account for lab assay variability.

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