What is the management for an 18-year-old with acetaminophen overdose?

From the Guidelines

Acetaminophen overdose management should start with N-acetylcysteine (NAC) administration as soon as possible.

Management Overview

• The patient should be admitted and monitored frequently, preferably in an ICU 1.
• NAC is the antidote for acetaminophen poisoning and should be given promptly in all patients where the quantity of acetaminophen ingested, serum drug level, or rising aminotransferases indicate impending or evolving liver injury 1.
• If acetaminophen ingestion is known or suspected to have occurred within a few hours of presentation, activated charcoal may be useful for gastrointestinal decontamination 1.

NAC Administration

• NAC can be given orally (140 mg/kg by mouth or nasogastric tube diluted to 5% solution, followed by 70 mg/kg by mouth q 4 h 17 doses) or intravenously (loading dose is 150 mg/kg in 5% dextrose over 15 minutes; maintenance dose is 50 mg/kg given over 4 hours followed by 100 mg/kg administered over 16 hours) 1.
• NAC has few side effects, including occasional nausea, vomiting, rare urticaria, or bronchospasm 1.

Treatment Timing

• Early treatment with NAC is crucial, and it may still be of value 48 hours or more after ingestion 1.
• The interval between drug ingestion and treatment with NAC is closely related to the outcome, so NAC should be started as early as possible 1.

From the FDA Drug Label

Keep out of reach of children Overdose warning: In case of overdose, get medical help or contact a poison control center right away.(1-800 222-1222). Quick medical attention is critical for adults as well as for children even if you do not notice any signs or symptoms The management for an 18-year-old with acetaminophen overdose is to get medical help or contact a poison control center right away [ 2 ].

• Quick medical attention is critical.
• Contact the poison control center at 1-800 222-1222.

From the Research

Management of Acetaminophen Overdose

The management of an 18-year-old with acetaminophen overdose involves several key steps:

• Assessment of the patient's condition and determination of the severity of the overdose
• Administration of activated charcoal to prevent further absorption of the drug
• Use of the acetaminophen nomogram to assess the need for treatment in acute immediate-release overdoses with a known time of ingestion 3
• Treatment with N-acetylcysteine (NAC) for patients at risk of acute liver injury 3, 4, 5
• Consideration of adjuvant treatments such as fomepizole and extracorporeal removal in cases of massive overdoses 6

Treatment Options

Treatment options for acetaminophen overdose include:

• N-acetylcysteine (NAC) as a safe and effective antidote for acetaminophen toxicity 4, 6
• Activated charcoal for gastric decontamination 3, 6
• Fomepizole as an adjuvant treatment in cases of massive overdoses 6
• Hemodialysis for early removal of the toxin in severe cases 6

Patient Care

Patient care for acetaminophen overdose involves:

• Close monitoring of the patient's condition and liver function
• Provision of supportive care, including mechanical ventilation and vasopressor support as needed 6
• Early identification and transfer of patients who are likely to require liver transplantation to a specialist liver centre 5