Patients who plot above the “300 line” on the Rumack-Matthew nomogram are at higher risk for hepatotoxicity. Update 1: Higher Maintenance Dosing for APAP Levels That Plot Above the “300 Line” Click image to enlarge. Here are the most important updates.Īs always, for specific advice on individual patients or for more information about the newer acetaminophen treatment strategies, call the Missouri Poison Center at 1-80. After thorough review of the literature, we have updated guidelines to include the best, most up-to-date recommendations. The management of acetaminophen overdose continues to evolve and has changed substantially over the last few years. Most facilities further streamlined the one-bag regimen into 2 doses instead of 3 after the loading dose, they continue maintenance therapy at the dose rate of the “middle bag” and never lower it to the rate of the “3 rd bag.”Ĭurrently, approximately half of the hospitals in Missouri still use the traditional 3-dose regimen, and half use the newer 2-dose regimen with programmable infusion pumps. The dose is individualized for each patient in one easy step at the bedside instead of multiple bags from the pharmacy and multiple bag changes at the bedside. The innovation that reduced these types of errors is the programmable infusion pump that uses a standardized IV bag with the same amount and concentration of NAC in each bag (hence the name, “one-bag method”). This complex situation leads to frequent dosing and administration errors. The problem was that the FDA-approved 21-hour, 3-dose regimen for intravenous NAC ( Acetadote) uses 3 separate IV bags with different amounts and different concentrations of NAC in each bag. It still offers some benefit even if initiated later than 8 hours.Ī revolutionary change in NAC dosing was introduced about 5 years ago. The antidote, n-acetylcysteine (NAC), given within 8 hours of ingestion prevents hepatotoxicity in most overdose cases by replenishing glutathione.
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