醫學筆記匯整 ED Notes

A toxic exposure to acetaminophen is suggested :

When a patient ≥ 6 years old ingests :
  (1) >10 g or 200 mg/kg as a single ingestion,
  (2) >10 g or 200 mg/kg over a 24-hour period, or
  (3) > 6 g or 150 mg/kg per 24-hour period for at least 2 consecutive days.

For children < 6 years old :
ingestion of 200 mg/kg or more of acetaminophen as a single ingestion or over an 8-hour period
or of 150 mg/kg per 24-hour period for the preceding 48 hours is considered a toxic exposure
 

  Stage 1  (< 24 hr) 
Minimal and nonspecific symptoms
Hypokalemia, met acidosis

  Stage 2  (2 - 3 day) 
Stage 1 symptoms improved
Clinical signs of hepatotoxicity may occur : RLQ pain and tenderness
Elevated serum transaminases

  Stage 3  (3 - 4 day) 

Fulminant hepatic failure
Metabolic acidosis, coagulopathy, renal failure,
Encephalopathy, and recurrent GI symptoms.

  Stage 4  ( 5 day) 
Patients who survive the complications of fulminant hepatic failure begin to recover over
the next 2 weeks (stage 4), with complete resolution of hepatic dysfunction in survivors after 1 to 3 months.

 

Rumack-Matthew nomogram
4 hour postingestion concentration > 200 micrograms/mL or > 1300 micromoles/L)
60% risk of developing hepatotoxicity (alanine aminotransferase >1000 IU/mL),
1% risk of renal failure, and a 5% risk of mortality.
 

A method to determine potential toxicity from IV acetaminophen
overdose has not been established.