Acetaminophen Poisoning: an Evidence-Based Consensus Guideline for Out-of-Hospital Management

Abstract

The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and initial management of patients with suspected ingestions of acetaminophen. An evidencebased expert consensus process was used to create this guideline. This guideline applies to ingestion of acetaminophen alone and is based on an assessment of current scientific and clinical information.

Characterisation and outcomes of adult patients with paracetamol overdose presenting to a tertiary hospital in Singapore

“…Based on a consensus guideline for out-of-hospital management of paracetamol overdose, evaluation at a medical facility is recommended if: (a) at least 10 g or 200 mg/kg (whichever is less) is ingested within an eight-hour period for single ingestion; (b) in the case of repeated supratherapeutic ingestion, at least 10 g or 200 mg/kg (whichever is less) is ingested within a 24-hour period; or (c) at least 6 g or 150 mg/kg (whichever is less) is ingested per 24-hour period for 48 hours or longer. (23) Bernal cited 7.5 g or 125 mg/kg as the minimum dose capable of causing hepatotoxicity. (24) Among the patients who developed severe hepatotoxicity in our study, the majority had ingested at least 10 g or 200 mg/kg within an eight-hour period.…”

webPOISONCONTROL: can poison control be automated?

“…To reduce the tremendous variability in triage practices [15], 17 US national triage guidelines were published from 2003 to 2008, but address only 107 ingredients [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. Most substances are not covered by national guidelines, and most poison centers have only a limited set of additional site-specific guidelines; thus, there is a high degree of triage variability both between and within centers and considerable time spent reassessing toxicity each time an exposure occurs.…”

Pediatric Atomoxetine Ingestions Reported to Texas Poison Control Centers, 2003–2005

“…The serious outcome rate (portion of total cases with serious medical outcomes) was determined for selected variables that might be expected to influence the severity or management of a case based on triage guidelines published by the American Association of Poison Control Centers (AAPCC) for other substances (Dart et al, 2006;Caravati et al, 2005;Manoguerra et al, 2005;Olson et al, 2005;Wax et al, 2005). The threshold for dose variables included in this analysis was based on double the manufacturer's recommended maximum daily dose for children and adolescents of 1.4 mg/kg or 100 mg (Eli Lilly and Company, 2006).…”