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Acetaminophen Overdose Smart Phrase

DescriptionThis is an Epic dot phrase for Tylenol poisoning, showing the basic plan based on the Prescott Protocol using N-acetylcysteine (Acetadote) as the primary treatment.

Acetaminophen ingestion treatment (Prescott Protocol):

  • GI decontamination
  • Activated charcoal
  • Antidote: N-acetylcysteine (NAC; Acetadote) for prophylaxis/prevention of acetaminophen-induced hepatic injury.
  • NAC Loading Dose: 150 mg/kg in 200 mL of 5% dextrose, infuse intravenously over 60 minutes.
  • NAC Maintenance Dose:
    • First 4 hours: 50 mg/kg in 500 mL of 5% dextrose, infuse intravenously over 4 hours
    • Followed by 100 mg/kg in 1000 mL of 5% dextrose, infuse intravenously over 16 hours
    • Refs: Daly et al, 2008; Prod Info ACETADOTE(R) IV injection, 2006; Prescott et al, 1979.
  • Monitor Acetaminophen levels Q12hr.
  • Initial Acetaminophen level ***.
  • Monitor LFTs Q12hr.
  • Initial hepatic enzymes: ALT ***, AST ***
  • Continue NAC therapy until serum acetaminophen concentration is undetectable and liver function improves (Smith et al, 2008).
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