study_ing
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its mentioned in Kaplan that when 24 hrs have elapsed since ingestion, there is no specific therapy whwich can prevent or reverse ingestion ( NAC is most efficacious within 8-10 hrs. geiven in ALL cases within 24 hrs).
- if a person comes after 24 hrs, duz that mean we dont give acetaminophen at all?
- also, if prz is early, gastric emptying is sometimes useful.( but it shudnt dealy nac administration) its also mentiond that activated charcoal is given in repeated doses.
- wudnt these interfere always with NAC administration?
- if the person's initial dose in >140 mg/kg, do we still need the nomogram?
will appreciate ur help 
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| sunny2
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Study_ing, this is what I think : (correct me if I am wrong, this is important to know clearly)
Untreated patients or those treated late (> 24 hours after ingestion), whose serum acetaminophen concentrations were above the nomogram line are considered at risk for hepatic necrosis, there is no specific therapy for them but we still give NAC and consult a hepatologist and transplant surgeon.
please note tht - NAC administration in cases of hepatic failure has been associated with decreased incidence of cerebral edema and improved survival.
Activated charcoal --if fewer than 2 hours have elapsed since the ingestion
But, Gastrointestinal decontamination could be particularly important if acetylcysteine cannot be administered within 8 hours of ingestion so continue with repaeated dose of charcoal.
Oral NAC administration may be staggered with activated charcoal if multiple doses of activated charcoal are necessary . Intravenous NAC administration may be prfered in this instance
if the person's initial dose is >140 mg/kg, we still need the nomogram, but would continue with the protocol as above (charcoal + NAC ) and wait for the result to document.
Also ,Patients can be observed at home if the dose ingested is less than 200 mg/kg
Patients 6 years of age or older should be referred to an emergency department if they have ingested at least 10 g or 200 mg/kg (whichever is lower) or when the amount ingested is unknown
and it is good to know this point too that if the initial contact with the hospital occurs more than 36 hours after the ingestion and the patient is well, the patient does not require further evaluation for acetaminophen toxicity .
I hope I answered every thing 
Have a nice day
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| study_ing
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thanks a lot..
u pretty much covered it all..brief and clear!
god bless u
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| tolito
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nice discussion, as usual by sunny2, but i have a comment on the following ''and it is good to know this point too that if the initial contact with the hospital occurs more than 36 hours after the ingestion and the patient is well, the patient does not require further evaluation for acetaminophen toxicity''
36hrs after ingestion is the 'honeymoon' period where the patient actually feels better. so even at that time after overdose ingestion, the patient should still be attended to and the normogram plotted. however, the prognosis is poor in those with more than 140mg/kg ingestion.
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| saadtazjam
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Any one knows how to give acetaminophen i mean dose and administration?
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| mimi222
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about giving charcole and nac together i can remember that its better to give charcol in between nac doses and preferably 1 hour apart to prevent its intraction with nac.
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