![]() Orogastric lavage or whole bowel irrigation is not effective. In alert patients, activated charcoal can be used. If the patient presents within 1 hour of ingestion, GI decontamination may be attempted. The treatment of acetaminophen poisoning depends on when the drug was ingested. There is usually less toxicity as the liver can regenerate its glutathione stores. Suspect and treat an overdose if the acetaminophen level is greater than 20 mcg/mL or if LFTs are elevated. In these cases, the provider must use risk factors, lab values, and clinical suspicion to determine whether or not there was significant ingestion. Acetaminophen levels do not correlate well with the degree of overdose. įor chronic acetaminophen ingestions, the Rumack-Matthew Nomogram cannot be applied. It can also only be applied to single acute ingestion. Serum levels must be drawn between 4 to 24 hours from the time of ingestion to use the nomogram properly. A level greater than 150 mcg/mL at 4 hours from ingestion is considered toxic. If serum levels fall into the toxic range based on the Rumack-Matthew Nomogram, then treatment should be initiated. Co-ingestions can be important, and a urine drug screen, EKG, and metabolic panel may be useful. Normally LFTs remain elevated in the second stage at 18 to 72 hours. If the ingestion is severe, LFTs can rise within 8 to 12 hours of ingestion. Other laboratory studies needed include liver function tests (LFTs) and coagulation profile (PT/INR). The diagnosis of acetaminophen toxicity is based on serum levels of the drug, even if there are no symptoms. There are also decreased stores of glutathione in alcoholics and patients with AIDS. Glucuronidation is dependent on carbohydrate stores, and more acetaminophen is converted to NAPQI in the malnourished patient. There is also increased activity of this enzyme in alcoholics and smokers, although acute intoxication with alcohol or cirrhosis can decrease the activity of cytochrome P450. Many anti-epileptic and anti-tuberculosis medications are known to increase the activity of cytochrome P450. An overdose depletes the stores of glutathione, and once they reach less than 30% of normal, NAPQI levels increase and subsequently bind to hepatic macromolecules causing hepatic necrosis. NAPQI is a toxic substance that is safely reduced by glutathione to nontoxic mercaptate and cysteine compounds, which are then renally excreted. In an overdose, these pathways are saturated, and more acetaminophen is subsequently metabolized to NAPQI by cytochrome P450. Do not use any other dosing device.Metabolism primarily occurs through glucuronidation and sulfuration, both of which occur in the liver. do not take for more than 10 days unless directed by a doctorĪttention: use only enclosed dosing cup specifically designed for use with this product.do not take more than 5 doses (100 mL) in 24 hours unless directed by a doctor.For adult dosing, the dosing cup needs to be filled to 10 mL line twice. take 20 mL (2 x 10 mL) every 4 hours while symptoms last.do not take for more than 5 days unless directed by a doctor.do not take more than 5 times in 24 hours unless directed by a doctor.repeat dose every 4 hours while symptoms last.remove the child protective cap and squeeze the dose into the dosing cup.If possible, use weight to dose otherwise, use age. (1-80) Quick medical attention is critical for adults as well as children even if you do not notice any signs or symptoms. Overdose warning: In case of overdose, get medical help or contact a Poison Control Center right away. If pregnant or breastfeeding, ask a health professional before use. These could be signs of a serious condition. fever gets worse or lasts more than 3 days. ![]() pain gets worse or lasts more than 5 days in children under 12 years. ![]()
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