Q: 27 year old female is in ICU after acetaminophen toxicity.
Patient was promptly started on N-acetylcysteine (NAC) in ER. Patient
after 10 hours of N-acetylcysteine (NAC)
infusion is clinically stable. Patient acetaminophen level is markedly down.
What would be your next step?
A) Continue N-acetylcysteine
(NAC)
B) stop N-acetylcysteine (NAC) to avoid fluid
overload
C) check Amylase and
Lipase
D) Check ABG and LFT and if
normal - discharge patient home
Answer: A
The entire NAC protocol, should be
completed even if patient clinically stabalizes or the acetaminophen plasma
levels decreases. There is no reason to check amylase lipase if clinical signs
are normal. Also, it may help to keep eye on ABG and LFT but patient should be
kept in hospital till completely clear, as extended release forms of drug may
bounce back the level.
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