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Acetaminophen Poisoning: Diagnosis and Treatment

Author: Dana Bartlett, RN, BSN, MSN, MA, CSPI and Kellie Wilson, PharmD

CE: 3 hours Pharmacology: 3 hours
Rated 4.6 out of 5.0 based on 25676 reviews

Course Summary

Acetaminophen poisoning is the most common cause of acute liver failure in the United States and other countries. Acetaminophen overdose can cause renal and other organ system damage, although this is rare. After a chronic overdose, the toxic dose of acetaminophen depends on how long the patient has been taking the drug and the presence of risk factors. Use of the Rumack-Matthew nomogram helps to determine whether an acute acetaminophen ingestion can be expected to be toxic or non-toxic. In chronic acetaminophen use, a serum level should be measured to determine the need for treatment. The standard treatment for acetaminophen overdose is activated charcoal, and N-acetylcysteine if the clinician determines N-acetylcysteine is needed. Other antidotal therapies may also be considered. If a patient is treated appropriately and promptly, the prognosis is typically good. In some cases, liver transplantation is needed.

Course Format


Course Syllabus

I.    Introduction

II.    Incidence of Acetaminophen Overdose

III.    Acetaminophen: Pharmacology

1. Labeled Uses and Mechanism of Action
2. Pharmacokinetics
3. Dosing
4. Available Forms
5. Contraindications, Cautions and Side Effects
6. Drug-Drug Interactions

IV.    Acetaminophen: Toxic Dose

V.    Therapeutic Dose and Toxicity

VI.    Repeated Supratherapeutic Ingestion and Overdose

VII.    Clinical Presentation of Acetaminophen Poisoning

1. Phase I
2. Phase II
3. Phase III
4. Phase IV
5. Renal and Other Organ Injury

VIII.         Risk Factors of Acetaminophen Poisoning

1. Alcohol and Acetaminophen Poisoning
2. Age
3. Genetics
4. Chronic Liver Disease
5. Poor Nutritional Status
6. Cigarette Smoking
7. Medications
8. Intrahepatic Glutathione Levels
9. Acute Viral Illness

IX.         Diagnosis of Acute Acetaminophen Overdose

1. Serum Acetaminophen Level
2. Laboratory Tests
3. Rumack-Matthew Nomogram
4. Repeated Supratherapeutic Ingestion, Delayed Presentation, and Unknown Time of Ingestion

X.         Treatment of Acetaminophen Overdose

1. Activated Charcoal
2. N-Acetylcysteine (NAC)
3. Fomepizole
4. Acetaminophen Overdose: Ambiguous and/or Missing Data

XI.         Special Cases of Acetaminophen Poisoning: Pregnancy and Liver Failure

1. Pregnancy and Acetaminophen Overdose
2. Acute Liver Failure

XII.    Case Study: Acetaminophen Poisoning


XIII.    Summary


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