Treatment-Acetaminophen hepatotoxicity

NG lavage, activated charcoal if w/in 4 h. Consider early transfer to transplant ctr

N-acetylcysteine: administer up to 72 h after ingestion, if time of ingestion unknown or chronic ingestion >4g/d; low threshold to start NAC w/ low or undetectable APAP levels

PO NAC (preferred): 140 mg/kg loading dose → 70 mg/kg q4h × 17 additional doses

IV NAC: 150 mg/kg × 1 h → 50 mg/kg × 4 h → 100 mg/kg × 16 h; risk of anaphylaxis (↓ w/ 12-h regimen; Lancet 2014;383:697); use if unable to tolerate POs, GIB, pregnancy, liver injury