Justice
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A serum acetaminophen concentration drawn 4 or more hours after a single ingestion may be plotted on the Rumack-Matthew nomogram as a guide to recommended NAC therapy. The nomogram is not applicable after multiple or chronic ingestions. It may be less reliable following ingestions that include anticholinergics or opioids or extended-release formulations.
Since NAC is safe and free of adverse effects, treatment should be initiated after 4 hours following acetaminophen ingestion (up until 48 hours), when blood levels exceed the threshold for risk (150 mg/ml at 4 hours and 20 mg/ml at 16 hours), or when there is a delay in obtaining acetaminophen blood levels.
If the levels at these timepoints do not exceed the above levelsl, just watch...
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