Dx1
APAP toxicity usually seen with ingestions of >10g or 200mg/kg in 24hr OR >6g or 150mg/kg QD x2d
SSx
- N/V
- Anorexia
- Abd pain
- HypoK
- Abnormal LFTs
- Encephalopathy
- Jaundice
- Anuria
Workup
- Serum APAP >4hr post-ingestion for nomogram below
- Others as indicated
- Serum ASA
- Chem7
- CBC
- LFTs
- SCr / BUN
- Urine Tox
Tx1,2
- Use Rumack-Matthew Nomogram
- if level not available w/i 8hr, treat empirically
- Activated Charcoal 1g/kg if recent exposure, preferably w/i 1hr, but maybe 3-4hr post-exposure
- NAC as dosed below if above nomogram line or if >24hr
post-exposure w/ level >10 mcg/mL (mg/L)
- Dosing wt NTE 100kg
- 100mg/kg IV over 15-60min
- then 50mg/kg IV over 4hr
- then 100mg/kg IV over 16hr
- all in D5W
- PO therapy also available
- watch for tinnitus and anaphylaxis
- Admit
- consider transplant if AMS, PTT >100, pH < 7.3, or SCr > 3.3 after delayed therapy (>24hr post-exposure)
APAP Nomogram1
References
-
Tintinalli JE, Stapczynski JS, Ma OJ, Cline D, Meckler GD, Yealy DM, eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. Eight edition. New York: McGraw-Hill Education; 2016. ↩ ↩2 ↩3
-
Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. ↩