1 Acetaminophen overdose remains common
A billion doses of acetaminophen are taken safely each year, but 10 000 people in Canada overdose on this medication annually. About one-third are hospitalized for treatment with the antidote, acetylcysteine, and 1%-2% die. (1) Most fatalities result from delayed presentation after deliberate overdose, or from excessive dosing for fever or pain over several days.
2 Clinicians should treat overdoses empirically with acetylcysteine, unless clearly unnecessary
Because the efficacy of acetylcysteine is highly time-dependent, it can be started for any acetaminophen overdose. (2) For acute overdoses that occurred at a reliably known time, acetylcysteine is not needed provided that the patient's peak acetaminophen concentration is below the Rumack-Matthew nomogram treatment line. Death from acetaminophen-induced liver failure is rare if acetylcysteine is started promptly. Dosed correctly, adverse reactions are rarely life-threatening. (3)
3 Acetylcysteine should be continued until the patient meets stopping criteria based on individualized serial testing
Although original treatment protocols stipulated a fixed treatment duration (e.g., 20 h), medical toxicologists now recommend a patient-tailored approach...