Changing nomogram risk zone classification with serial testing after acute acetaminophen overdose: a retrospective database analysis

The Multifaceted Therapeutic Role of N-Acetylcysteine (NAC) in Disorders Characterized by Oxidative Stress

“…To ensure the appropriate use of NAC to prevent liver injury from acetaminophen toxicity, a nomogram that plots acetaminophen plasma concentrations against the time of overdose was developed [ 63 ] and subsequently modified [ 60 , 61 ]. Although the current nomogram is conservative and has proven to be a reliable guide for NAC treatment after acetaminophen poisoning [ 64 ], treatment decisions based on a single measurement may not assess the risk completely, as patients who were initially stratified as below the treatment line, can cross the treatment threshold following overdose [ 65 ].…”

Anual Evaluation of “Drug Poisonings, Emergency Service” Studies Published in Pubmed 01.01.2019-01.01.2020

“…Half of patients after acute APAP overdose cross nomogram risk areas, the current treatment threshold 150 mg/ mL 4 hours after swallowing. Old age, male sex, independently of co-ingestants and final liver damage It is associated with a patient who moves to higher-risk areas (21).…”

Comment on “The changing face of paracetamol toxicity and new regimens for an old antidote acetylcysteine”

“…It is well documented that patients have been withheld treatment with NAC due to misinterpretation of the nomogram resulting in hepatotoxicity. 5 Concomitant overdosing of several drugs that delay the time to peak PCM concentration is common and may result in crossing from below to above the treatment line 5 leaving line crossers who required treatment untreated. The same is relevant in cases of massive PCM overdosing alone (drug bezoar) or poisonings with extended-release PCM formulations (late PCM peak).…”