Up-to-date treatment of acetaminophen poisoning

N-Acetylcysteine (NAC) is the standard antidote treatment for preventing hepatotoxicity caused by acetaminophen (AAP) poisoning. This review summarizes recent evidence of AAP Several alternative intravenous regimens NAC have been suggested to improve patient safety reducing adverse drug reactions and medication errors. A two-bag infusion regimen (200 mg/kg over 4 h, followed 100 16 h) reported similar efficacy with significantly reduced compared traditional 3-bag regimen. Massive poisoning due high concentrations (more than 300-lines in nomogram) needs be managed an increased maintenance dose NAC. In addition NAC, combination therapy hemodialysis fomepizole advocated severe cases. case a presenting altered mental status, metabolic acidosis, elevated lactate, concentration greater 900 mg/L, recommended even if used. Fomepizole decreases generation toxic metabolites inhibiting CYP2E1 may considered off-label use experienced clinicians. Since nomogram cannot applied sustained-release formulations, all potentially overdoses should receive full course ingesting less dose, tested twice at interval h or more; administered either value above 150-line nomogram.