The aim of management is to identify patients who should receive thiol-based antidote therapy and, in those with established severe liver injury, assess the patient’s candidacy for LT.īlood levels of acetaminophen should be measured at the time of presentation. Use of activated charcoal is contraindicated if there is airway compromise. Oral charcoal is most useful within the first 1 to 2 hours but can be used up to 4 hours in patients who present with a large overdose, after ingestion of a sustained-release preparation, or consumed drugs that impair gastric emptying concurrently. In patients who present within 4 hours of an acetaminophen overdose, the stomach should be emptied with a wide-bore NG tube.
Mark Feldman MD, in Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 2021 Treatment Administration of N-acetylcysteine is virtually 100% effective in preventing hepatotoxicity when administered within 8 hours of drug ingestion. All patients who are possibly or probably at risk of hepatotoxicity and anyone for whom the time of ingestion is not known are treated with N-acetylcysteine, which repletes glutathione, combines directly with NAPQI, and enhances sulfate conjugation of acetaminophen. At 4 hours after drug ingestion, plasma acetaminophen concentration should be measured and plotted on the Rumack-Matthew nomogram, which stratifies patients into those who are not at risk of hepatotoxicity, those who are possibly at risk, and those who are probably at risk ( Fig. Treatment of acetaminophen overdose begins with determination of the time of drug ingestion and with administration of activated charcoal to impede drug absorption. In overdose, the supply of glutathione becomes depleted and NAPQI is not detoxified. Normally this metabolite constitutes only 5% of acetaminophen metabolic products and is inactivated by conjugation with endogenous glutathione. Acetaminophen toxicity is due to centrilobular hepatic necrosis caused by N-acetyl- p -benzoquinoneimine ( NAPQI), which reacts with and destroys hepatocytes. Patients typically have nausea and/or vomiting and abdominal pain at presentation.
Hines MD, in Stoelting's Anesthesia and Co-Existing Disease, 2018 Acetaminophen OverdoseĪcetaminophen overdose is the most common medicinal overdose reported to poison control centers in the United States.
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