Thursday, December 4, 2014

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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