Acetaminophen Toxicity
Considerations
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Emergency situation, full stomach
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Co-intoxications may exist
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Uncooperative patient (encephalopathy, toxic ingestions, suicidality)
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Multisystem effects of acute liver injury/failure (usually only > 24 hours after ingestion):
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CVS: hypotension
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CNS: encephalopathy, cerebral edema
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GU: renal failure
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GI: nausea/vomiting, acute hepatic failure
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Hematology: anemia (GIB), coagulopathy
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Early provision of therapy:
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Oral activated charcoal < 1hr
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N-acetyl cysteine (NAC) according to treatment nomogram
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Disposition to ICU for monitoring & supportive care
Pregnancy Considerations
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Identical management with NAC nomogram (both acetaminophen & NAC cross placenta)
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Multdisciplinary: obstetrics, pediatrics, NICU consultations
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Risk of fetal compromise:
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FHR monitoring
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Consider caesarean section
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