DescriptionThis is an Epic dot phrase for Tylenol poisoning, showing the basic plan based on the Prescott Protocol using N-acetylcysteine (Acetadote) as the primary treatment.
Acetaminophen ingestion treatment (Prescott Protocol):
- GI decontamination
- Activated charcoal
- Antidote: N-acetylcysteine (NAC; Acetadote) for prophylaxis/prevention of acetaminophen-induced hepatic injury.
- NAC Loading Dose: 150 mg/kg in 200 mL of 5% dextrose, infuse intravenously over 60 minutes.
- NAC Maintenance Dose:
- First 4 hours: 50 mg/kg in 500 mL of 5% dextrose, infuse intravenously over 4 hours
- Followed by 100 mg/kg in 1000 mL of 5% dextrose, infuse intravenously over 16 hours
- Refs: Daly et al, 2008; Prod Info ACETADOTE(R) IV injection, 2006; Prescott et al, 1979.
- Monitor Acetaminophen levels Q12hr.
- Initial Acetaminophen level ***.
- Monitor LFTs Q12hr.
- Initial hepatic enzymes: ALT ***, AST ***
- Continue NAC therapy until serum acetaminophen concentration is undetectable and liver function improves (Smith et al, 2008).