Acetaminophen

A 35 year old man is brought to the ED by a friend after he attempted to commit suicide by ingesting a bottle of acetaminophen. What is the next best step in management?

Presentation

• Day 1 (first 24h)
  • nausea
  • vomiting
• Day 2-3 (48-72h)
  • hepatic failure
• Amount ingested
  • 10 g is toxic
  • 15 g is fatal
  • amounts are lower if liver disease or alcohol abuse

Diagnosis

• Acetaminophen level: get this if the amount ingested is not known and not sure if it was enough to cause toxicity. Remember, treatment is more important than knowing the acetaminophen level, so give N-acetylcysteine right away if suspected overdose, don’t wait on the acetaminophen level.

Management

N-acetylcysteine (NAC)

• give to all suspected acetaminophen overdoses
• can be given IV
• helps prevent liver toxicity within 24 hours of acetaminophen ingestion
• after 24h, the liver toxicity of acetaminophen can’t be reversed with any specific therapy