She complains of nausea and vomiting and admits this was an attempt to harm herself. Monitoring of patients with a should include repeated neurologic and hemodynamic assessment.Author: Maryam Abdrabbo, PharmD Candidate 2018 (Rutgers Ernest Mario School of Pharmacy, New Brunswick NJ), Cynthia Santos, MD (Assistant Professor Emergency Medicine, Medical Toxicology, Rutgers NJMS) // Edited by: Alex Koyfman, MD EM Attending Physician, UTSW / Parkland Memorial Hospital), and Brit Long, MD EM Attending Physician, San Antonio, TX)Ī 19-year-old woman is brought into the ED by family members after she reported ingesting 35 Tylenol tablets (Extra-Strength) 2 hours ago. Additionally, caution should always be used when intravenous NAC is prescribed and the amount of diluent is calculated. The total dose is 300 mg/kg delivered over 21 hours. Adults should receive 150 mg/kg administered for 45 minutes, followed by 50 mg/kg administered for 4 hours, followed by 100 mg/kg administered for 16 hours. The most common anaphylactoid reactions include rash, flushing, and bronchospasm. However, caution should be used in patients who have experienced previous hypersensitivity or anaphylactoid reactions to intravenous NAC, as well as in patients with asthma. Intravenous NAC is indicated in patients who present with a history of acetaminophen overdose within the previous 8 to 10 hours, patients unable to tolerate oral NAC, and patients who present with evidence of fulminant hepatic failure. NAC replenishes hepatic glutathione and may also act as a glutathione substitute, combining directly with the toxic metabolite. In overdose, hepatic stores of glutathione are depleted and NAPQI binding to hepatocytes induces cell death and hepatic necrosis. Acetaminophen is metabolized to N-acetyl-p-benzoquinone imine (NAPQI), which is detoxified by conjugation with glutathione. However, if treated early, patients with acetaminophen poisoning generally recover uneventfully. Liver failure may occur in severe toxicity. Acetaminophen toxicity may occur acutely when supratherapeutic amounts are ingested purposefully or unintentionally. Acetaminophen is a commonly used analgesic and antipyretic agent, and its use is one of the most common causes of poisoning worldwide. ABSTRACT N-acetylcysteine (NAC) is widely recognized as the antidote of choice for acetaminophen overdose.
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