The dark side of acetaminophen - Jennifer Yang
The first acetaminophen level should be drawn at 4 hours post-ingestion, as levels done before this are uninterpretable because absorption and distribution of the drug may not be complete. If the patient presents greater than 24 hours post-ingestion, the level could be zero despite toxicity so liver function tests should be drawn. If a decision is made to admit and treat the patient then a CBC, PT, PTT, BUN, Creatinine, electrolytes, bilirubin, and transaminases should be drawn and repeated every 24 hours until discharge.
To interpret the serum acetaminophen level, the time of ingestion must be established as accurately as possible and the level plotted on the Rumack-Matthew normogram.…
N-acetylcysteine (NAC or Mucomyst) is the specific antidote for acetaminophen toxicity. NAC given before 8 hours post-ingestion eliminates mortality and brings morbidity to a few percent (the 8-hr window). Its efficacy diminishes beyond 8 hours, and diminished further beyond 16 hours post-ingestion. Failure to recognize and treat acetaminophen toxicity within 16 hours results in significant morbidity and mortality.
Acetaminophen is in more than 600 prescription and over-the-counter medicines. When used as directed it’s safe and effective, but taking too much can lead to liver damage. Do you know your dose?
Toxicity is typically divided into stages, but this may not work perfectly in every patient (especially in patients who ingested several doses of acetaminophen over time).
Acetaminophen toxicity is the second most common cause of liver transplantation worldwide and the most common in the US.
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