Acetaminophen overdose in pregnancy

 Q: The acetaminophen overdose in pregnancy should be approached with a higher dose of N-acetylcysteine? 

A) True

B) False

Answer: B

Acetaminophen crosses the placenta and potentially may cause fetal death from hepatic necrosis. The approach to the treatment in pregnancy with acetaminophen overdose is not different from any other patient, as the effect on the liver is similar.  Dosing and the duration of treatment stay the same. Either oral or IV route has the same effect but the IV route is preferred as a pregnant patient may have increased nausea and vomiting. 

Lengthening the N-acetylcysteine treatment in pregnancy may increase the risk of miscarriage and fetal death.

Moreover, if a baby is born with toxic acetaminophen concentrations, he/she should be treated with N-acetylcysteine with standard dosing.

#Ob-Gyn

#hepatology

#toxicology

References:

1. Haibach H, Akhter JE, Muscato MS, et al. Acetaminophen overdose with fetal demise. Am J Clin Pathol 1984; 82:240. 

2. McElhatton PR, Sullivan FM, Volans GN. Paracetamol overdose in pregnancy analysis of the outcomes of 300 cases referred to the Teratology Information Service. Reprod Toxicol 1997; 11:85. 

3. Lederman S, Fysh WJ, Tredger M, Gamsu HR. Neonatal paracetamol poisoning: treatment by exchange transfusion. Arch Dis Child 1983; 58:631. 

4. Horowitz RS, Dart RC, Jarvie DR, et al. Placental transfer of N-acetylcysteine following human maternal acetaminophen toxicity. J Toxicol Clin Toxicol 1997; 35:447.