Treatment of acetaminophen overdose

The therapeutic management of patients with acetaminophen overdose is revie wed. Acetaminophen overdose results in more calls to poison control centers in t he United States than overdose with any other pharmacologic substance. Alth ough the optimal management strategy remains controversial, the literature suggests a general approach that can be followed until there is evidence su pporting a different strategy. A single dose of activated charcoal should b e administered within one hour of acetaminophen overdose. Other means of ga stric decontamination are not warranted. Acetylcysteine should be given if the acetaminophen concentration exceeds the treatment line in the Rumack-Ma tthew nomogram. If a patient is treated within 10 hours of acetaminophen in gestion, the risk of hepatoxicity is low. In patients 10-24 hours after ing estion, a 72-hour oral or 48-hour i.v. acetylcysteine regimen should be use d. Among patients with fulminant hepatic failure, acetylcysteine should be given until recovery or death occurs. In patients who have taken extended-r elease acetaminophen, the acetaminophen concentration should be measured at four hours and, if this level exceeds the treatment line, acetylcysteine s hould be started immediately. If the concentration is below the treatment l ine, a second acetaminophen concentration should be determined four to six hours later. If this level is above the treatment line, acetylcysteine ther apy should be started. Cimetidine appears to have no role in the management of acetaminophen overdose. Children should be diagnosed and treated the sa me way as adults, and pregnant patients should be managed no differently th an nonpregnant patients. An evaluation of the literature on acetaminophen poisoning verifies the use fulness of acetylcysteine as a hepatoprotective agent. A single dose of act ivated charcoal may also be useful if given within one hour of acetaminophe n ingestion.