Vietnamese
Forum Elite
Topics: 12
Posts: 285
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As soon as possible but 16 hs is acceptable. Experts recommend 24-36 hs is also acceptable if severe.
Remember before 4 hs level is not measurable but Rx go ahead.
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| hero
Forum Guru
Topics: 42
Posts: 557
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--immediately as you suspect or after lab confirmation --
if pt appeared 2-4 hours after ingestion
and he states that it might be pain killer, might be acetaminophen
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| WaqasQureshi
Forum Senior
Topics: 5
Posts: 178
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you can go with any of them. The options wont appear at a time  incase they do, go with the first one (USMLEWORLD)
reason:
- there is no significant difference in first 8 hours as far as NAC admin is concerned
- secondly, you cant measure levels before 4 hours
- thirdly, sometimes you dont need to admin it in case of low toxc levels so it's kind of COST EFFECTIVE thingee
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| vnty
Forum Senior
Topics: 24
Posts: 87
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Administer N-acetylcysteine, if indicated. Early administration of NAC, within 8 hours of ingestion, is nearly 100% hepatoprotective. NAC should be administered while awaiting a serum acetaminophen level if the patient presents close to or later than 8 hours postingestion or if the patient is pregnant.
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| DrVirgo
Forum Hero
Topics: 1096
Posts: 3,515
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As per UW:
If the acetaminophen OD presents before 4 hours, give activated charcoal.
At 4 hours get a level. Give NAC by 8 hours.
As per Kap:
If a clear history of Acetaminophen OD is established, you can start NAC.
Get a level at 4 hours (most reliable).
-Gastric emptying is useful within the first hour, but SHOULD NOT DELAY NAC administration.
-NAC is given in ALL cases w/in 24 hours of ingestion.
-NAC is most effective within the first 8-10 hours.
So if the patient presents at 1 hour after OD what do you do?
What if he presents at 2, 3, 4, and 5, hours?
Is the management different?
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