Treating acetaminophen overdose.

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Date: Apr. 19, 2022
From: CMAJ: Canadian Medical Association Journal(Vol. 194, Issue 15)
Publisher: CMA Impact Inc.
Document Type: Article
Length: 675 words
Lexile Measure: 1680L

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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...

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Gale Document Number: GALE|A700407654