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Acetominophen Overdose

Sean Nordt, MD PharmD FAAEM and Stuart Swadron, MD, FRCPC
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Acetominophen OD. What's the treatment? NAC? Charcoal? Both? I need to know.

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Jared R, EMT-P -

Recently had a patient (prehospital) that was diagnosed in the ED with a Acetaminophen OD. Level of 225. Can a level be used to infer an ingestion dose? or is that dependent on pt physiology?

Paul B., M.D. -

In this section it stated that hepatologists use NAC for any kind of liver insults. Is there any practical use for NAC in alcoholic hepatitis?

Sean N. -

Hi Jared,

Thanks for comment.

Could you clarify? What do you mean pre-hospital? Before 4 hours?

If your patient had a level of 225 mg/L (approx 1300 mmol/L) would confirm an ingestion. Would have to be plotted on nomogram if time of ingestion known if single ingestion. If time not known or more than single ingestion would treat as acetaminophen poisoning and start NAC ASAP.

Sean N. -

Hi Paul,

Thanks for the comment.

Yes, would recommend NAC in alcoholic hepatitis.

There is limited data to suggest useful and very little downside. Oral NAC is what I would recommend if can tolerate as safer profile than IV and being unsure of benefit, unlike acetaminophen where proven beneficial.

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