Acetaminophen overdose

Today’s episode talks about the diagnosis and management of Acetaminophen overdose.  This is another addition to the EM Basic Project written by Dr. Andrea Sarchi.

We encounter acetaminophen overdose frequently in the ED and we need to be on the look out for this because patients can be completely asymptomatic.  If we don’t catch it, acetaminophen overdose can result in liver failure requiring transplant or even death unless we interevene early.  This episode will review how to properly workup a patient with a known or suspected acetaminophen overdose, what tests to order, and how to decide who needs antidote therapy.

Acetaminophen overdose podcast

Acetaminophen Overdose Show Notes (Word Format)

Acetaminophen Overdose Show Notes (PDF)

Mentioned in the podcast:

FOAMcast– a new project by Drs. Lauren Westafer and Jeremy Faust to review the core content behind current FOAMed blog posts and podcasts.  Available on iTunes

Rumack-Matthew Nomogram (to determine when to use NAC)


NAC Protocol:

72-hour PO protocol – loading dose 140 mg/kg PO, then 70 mg/kg PO every 4 hrs for 17 total doses

21-hour IV protocol – loading dose 150 mg/kg over 1 hr, then 4-hr infusion of 12.5mg/kg/hr, then 16-hr infusion at 6.25 mg/kg/hr