Acetaminophen Toxicity 

 

 

Considerations

 

  • Emergency situation, full stomach 

  • Co-intoxications may exist 

  • Uncooperative patient (encephalopathy, toxic ingestions, suicidality)

  • Multisystem effects of acute liver injury/failure (usually only > 24 hours after ingestion):

    • CVS: hypotension 

    • CNS: encephalopathy, cerebral edema

    • GU: renal failure

    • GI: nausea/vomiting, acute hepatic failure

    • Hematology: anemia (GIB), coagulopathy

  • Early provision of therapy:

    • Oral activated charcoal < 1hr

    • N-acetyl cysteine (NAC) according to treatment nomogram 

  • Disposition to ICU for monitoring & supportive care

 

 

Pregnancy Considerations

 

  • Identical management with NAC nomogram (both acetaminophen & NAC cross placenta)

  • Multdisciplinary: obstetrics, pediatrics, NICU consultations

  • Risk of fetal compromise:

    • FHR monitoring

    • Consider caesarean section 

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