Acetaminophen is in everyone's medicine cabinet. This makes it one of the more common intoxications. At first blush, this might seem like an easy topic: apply the nomogram, then give acetylcysteine. Unfortunately, it's not quite that simple. There are a variety of different presentations (e.g. acute, chronic, delayed), many of which will confound the nomogram. Treatment of the most extreme form (massive acetaminophen intoxication) remains debatable.
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Hi Josh
I’m dealing with a case of paracetamol poisoning which lead to a bad outcome. In my case, the ALT & paracetamol levels both haemolysed twice, from her presentation in the ED. The blood result wasn’t available until 9 hours after registering in the ED.
In the event of suspected paracetamol ingestion, if the first level haemolyses, would you start NAC immediately?
Interested in hearing the thoughts of the readers and yourself on this one.
Dean
I can’t speak to your particular case, but when in doubt I think the safest thing to do is to start NAC. You can always stop it later once levels come back. Of course this depends on clinical index of suspicion – if there is *no* reason to suspect acetaminophen then empiric NAC might not be warranted.