The Rumack-Matthew nomogram (the acetaminophen toxicity nomogram or acetaminophen nomogram), is used to interpret serum. The Rumack-Matthew nomogram uses the serum acetaminophen concentration, in relation to the time after ingestion, to assess potential. The Rumack-Matthew nomogram, also known as Rumack-Matthews nomogram or the acetaminophen nomogram is an acetaminophen toxicity nomogram.

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An informed decision should be made when stopping NAC, which requires assessing that the risk of developing toxicity is low [APAP] is undetectable, ASTs are normaland any toxicity that occurred has been resolved.

Formula Actual body-weight dosing, starting with loading dose and then variable rates depending on PO vs. Please fill out required fields. Related Bing Images Extra: A formal half life may also be determined.

Serum concentrations above the treatment acetaminophhen indicate the need for N-acetylcysteine NAC therapy. Emergency Physician working in Vancouver.

It is highly recommended to consult with a poison control center or medical toxicologist when considering the discontinuation of acetylcysteine prior to the conclusion of a full course of therapy. By using this site, you agree to the Terms of Use and Privacy Policy.

Paracetamol is a hard overdose to understand. A known time of ingestion. This was published in Lexi-Comp Accessed Aug Subcategory of ‘Diagnosis’ designed to be very sensitive Rule Out.


If the patient has a staggered overdose throughout the day over 8 hourse. Nomoggram acetaminophen concentration on Rumack-Matthew nomogram see above.

Acetaminophen Toxicity

This page was last edited on 12 October bomogram, at But what about extended release, what if they have co-ingestants, what if they took multiple does of paracetamol at different times? Algorithm for the Management of Atrial Fibrillation. Poisoning by acetaminophen C Start NAC and time anchor the paracetamol concentration to Efficacy declines after this point.

It is the practise of some clinical toxicologists to increase the acetylcyteine dose. The Rumack-Matthew acetaminophn is the most sensitive risk prediction tool in medical toxicology.

Normally paracetamol is conjugated with glucuronide and excreted in the urine. Content is updated monthly with systematic acetamiinophen reviews and conferences. Screening and testing for paracetamol in the first 24 hours is necessary as patients are asymptomatic with toxic doses.

Give activated charcoal if they present within 2 hours 2.


If above treatment line, NAC should be initiated within 8 hours post-ingestion. Languages Italiano Edit links. If a paracetamol concentration cannot be determined within 8 hours, start NAC until the results are available. Maintain a strong index of suspicion for acetaminophen toxicity in all patients with intentional drug overdose and those with therapeutic misadventures e. Lowers the threshold for N-Acetylcysteine use baseline glutathione deficiency Dehydration, Fastin g or Malnutrition Alcohol Abuse Cirrhosis Concurrent use of other medications Isoniazid reports of hepatotoxicity with concurrent Acetaminophen 3.


Activated charcoal can also be considered up to 4 hours after time of ingestion in massive paracetamol overdose.

If paracetamol concentration result can be determined before 8 hourswait, plot against the nomogram and treat as appropriate. Not validated before 4 hours or after 16 hours 4. Beyond 24 hours the patient should be symptomatic therefore, start NAC if the patient has nausea, vomiting, abdominal pain or encephalopathy. Applies only to single acute paracetamol nomobram of immediate-relate 2.

This allows for the worst case scenario. There is a small risk acetaminopuen this approach that there could be unabsorbed acetaminopjen in the GI tract if a lot of paracetamol was taken later during the eight hour period. It has a prolonged absorption phase with peak concentration occurring within hours but maybe delayed up to 20 hours in overdose. NAC continues until the paracetamol concentration is undetectable and hepatic transaminases are stable or falling and the patient is clinically improving.

Treatment should begin within 8 hours of ingestion or as soon as possible after ingestion. If half-life is more than 4 hours, then treatment is necessary to prevent hepatotoxicity and liver failure.