Management of Acetaminophen Poisoning - 2000

<8 H After Overdose

Measure plasma acetaminophen level.
Administer activated charcoal 1-2g/kg for a child or 30-50 g for an adult.
Administer N-Acetylcysteine (NAC) if plasma level is above treatment line on Rumack-Matthew nomogram.
If plasma level is not available by 8 h but > 150 mg/kg acetaminophen has been ingested (140 mg/kg in a child), begin treatment with NAC
Prior to, or shortly after the first dose of NAC, determine PT and obtain ALT, AST, BUN, and creatinine levels. Acetaminophen levels as well as the other laboratory levels should be obtained daily until treatment has been completed and/or they return to normal.
If patient is asymptomatic and test results are normal, no risk of complication exists. NAC treatment may be stopped and patient discharged.

15-24 H After Overdose

Start the full course of NAC if > 150 mg/kg acetaminophen has been ingested without waiting for lab results.
Obtain plasma acetaminophen level; PT; ALT, AST, creatinine, and bilirubin levels; acid-base status; and CBC.

>24 H After Overdose

Obtain plasma acetaminophen level; PT; ALT, AST, cretinine, and bilirubin levels; acid-base status; and CBC.
Start NAC if > 150 mg/kg acetaminophen has been ingested, patient is symptomatic, or tests are abnormal.