Rumack-Matthew Nomogram for Acetaminophen 1
Obtain a 4-hour level (or later, up to 24 hours) to get estimated peak absorption (that is, if time of ingestion is certain).įigure 1. Getting an APAP level 1 to 4 hours after ingestion may be helpful only to exclude ingestion of APAP (that is, if the level is zero). Stages of Acute Acetaminophen Poisoning 1,3 100 mg/kg/day over 72 hour period or greater. 150 mg/kg/day or 6 g/day (whichever is less). (Note: more likely to see doses >200 mg/kg cause toxicity). Chronic overdose occurs with repeated supratherapeutic ingestions (greater than an 8-hour period). Acute overdose is arbitrarily defined as an entire ingestion within a single 8-hour period. Examples include cough and cold products, migraine medications (which also could contain aspirin like Excedrin® Migraine), etc. This can be one of the causes for chronic APAP toxicities. Many OTC combination products contain acetaminophen! The time to peak may be extended by coingestion of opiods or anticholinergics. Therefore, one can assume for all ingested formulations (whether IR or ER), most APAP is absorbed at 4 hours. ER – majority is absorbed within 4 hours. IR – majority is absorbed within 2 hours. There are immediate- and extended-release formulations. Her weight is 54 kg.Ī cetaminophen (APAP) comes in different strengths and formulations. She complains of nausea and vomiting and admits this was an attempt to harm herself. 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.
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