Elsevier

Annals of Emergency Medicine

Volume 50, Issue 3, September 2007, Pages 292-313
Annals of Emergency Medicine

Toxicology/clinical policy
Clinical Policy: Critical Issues in the Management of Patients Presenting to the Emergency Department With Acetaminophen Overdose

https://doi.org/10.1016/j.annemergmed.2007.06.014Get rights and content

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Abstract

This clinical policy focuses on critical issues concerning the management of patients presenting to the emergency department (ED) with acetaminophen overdose. The subcommittee reviewed the medical literature relevant to the questions posed. The critical questions are:

  • 1

    What are the indications for N-acetylcysteine (NAC) in the acetaminophen overdose patient with a known time of acute ingestion who can be risk stratified by the Rumack-Matthew nomogram?

  • 2

    What are the indications for NAC in the

Methodology

This clinical policy was created after careful review and critical analysis of the medical literature. MEDLINE searches for articles published between January 1974 and January 2006 were performed using a combination of key words and their variations, including “acetaminophen,” “paracetamol,” “APAP,” “extended release,” “acetylcysteine,” “N-acetylcysteine,” “Mucomyst,” “NAC,” “liver disease,” “aminotransferase,” “aspartate transaminase,” “alanine transferase,” “SGOT,” “AST,” “ALT,” and

Critical Questions

  • 1

    What are the indications for NAC in the acetaminophen overdose patient with a known time of acute ingestion who can be risk stratified by the Rumack-Matthew nomogram?

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