9 Aug 2023 • An expert panel has updated recommendations for emergency department assessment, management, and treatment of acetaminophen poisoning. The panel emphasized the role of the patient's history; an inaccurate estimate of the time of ingestion, for example, can lead to the erroneous conclusion that acetylcysteine, is not needed or can be discontinued prematurely — a potentially fatal mistake.

The initial dose of acetylcysteine should be administered as soon as the need becomes evident, with the panel recommending at least 300 mg/kg orally or intravenously during the first 20 or 24 hours of treatment. When acetaminophen is co-ingested with anticholinergic or opioid agonist medications, management is the same, except if the first acetaminophen concentration measured at 4-24 hours after ingestion is 10 μg/mL or less, another measurement and acetylcysteine treatment are not needed.

"A guideline that provides management guidance could optimize patient outcomes, reduce disruption for patients and caregivers, and reduce costs by shortening the length of hospitalization," write the authors.

The study was published online August 8 in JAMA Network Open.

Source: JAMA Network Open | Read full story