Acetaminophen Overdose

Check Acetaminophen levels and urine toxicology for co-ingestions

1. Call poison control
2. NGT, lavage with 2 L NS
3. Activated charcoal: Give a single dose of activated charcoal at 1 g/kg p.o. via NG tube within 4 hours of ingestion
4. N–Acetylcysteine: Passive given within 8 hours of ingestion and before ALT begins to rise, can give a charcoal
5. Oral dosing of acetylcysteine: 140 mg/kg loading dose followed by 17 doses of 70 mg.kg every 4 hours.  If patient vomits within 1 hour administration give full dose again
6. Give acetylcysteine based on the nomogram.  If unable to obtain level just treat.
7. Follow acetaminophen levels q4h, LFT, PT/PTT
8. Evaluate potential need for liver transplant; pH < 7.3, Cr > 3.4, INR >6.5

References:

1. Hospitalist Handbook, iPhone App

2. UpToDate -- Acetaminophen Overdose

3. NCBI