Recommendations developed for acetaminophen poisoning

In a consensus statement published online Aug. 8 in JAMA Network Open, recommendations are presented for the management of patients with acetaminophen poisoning.

Richard C. Dart, M.D., Ph.D., from the University of Colorado School of Medicine in Denver, and colleagues from four clinical toxicology societies (America’s Poison Centers, American Academy of Clinical Toxicology, American College of Medical Toxicology, and Canadian Association of Poison Control Centers) developed consensus guidelines for the management of acetaminophen poisoning in the United States and Canada.

The panel developed guidelines for emergency department management of acetaminophen ingestion. In addition, extended-release formulation, high-risk ingestion, coingestion of anticholinergics or opioids, age younger than 6 years, pregnancy, weight greater than 100 kg, and intravenous acetaminophen use were addressed. Differences from current practice in the United States included defining acute ingestion as ingestion presentation from four to 24 hours after initiation of overdose.

A revised Rumack-Matthew nomogram was developed. High-risk ingestion was used to replace the term massive ingestion and was denoted by a specific line in the nomogram.

Specific criteria for emergency department triage, laboratory evaluation and monitoring parameters, defining the role of gastrointestinal decontamination, management of acetylcysteine treatment, associated adverse effects, criteria for stopping acetylcysteine treatment, and criteria for consultation with a clinical toxicologist were also included as recommendations.

Specific treatment considerations were addressed, including dosing for acetylcysteine, fomepizole administration, and considerations for extracorporeal elimination and transplant evaluation.

“Future work should focus on refining critical elements of history-taking in poisoned patients, comparative effectiveness and safety research on various acetylcysteine regimens, and refining the clinical roles of fomepizole and hemodialysis in acetaminophen poisoning,” the authors write.

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