Treatment of Acetaminophen Overdose in ER

I had two cases of acetaminophene (Tylenol) overdose in the ER this week. Both cases patients require IV Acetadote (Acetylcysteine). There is a web site published by Cumberland Pharmaceuticals, maker of Acetadote. Here is the link: http://www.acetadote.net/. There is a dosing calculator on the web site which can do the calculations for you. You can also downloade the calculator to your PDA The website also offers information or how to order Acetadote and emergency locator.









Below are some keypoints:
1. Acetadote, administered intravenously within 8 to 10 hours after ingestion of a potentially
hepatotoxic quantity of acetaminophen, is indicated to prevent or lessen hepatic injury.

2. Three-bag treatment (for patients >=40kg)
The total dose of Acetadote is 300 mg/kg administered over 21 hours.
Loading Dose: Dilute 150 mg/kg in 200 mL of 5% dextrose and administer over 60 minutes.
Second Dose: Dilute 50 mg/kg in 500 mL of 5% dextrose and administer over 4 hours.
Third Dose: Dilute 100 mg/kg in 1000 mL of 5% dextrose and administer over 16 hours.
The total volume administered should be adjusted for patients less than 40 kg (88 lbs) and for those requiring fluid restriction. To avoid fluid overload, the volume of 5% dextrose should be reduced as needed.


3. Renal adjustment/Hepatic adjustment
No data on renal/hepatic dosing adjustment