Acetaminophen_Overdose_and_NAC_Dosing v.1

Acetaminophen Overdose and NAC Dosing calculates PO/IV NAC dosing for acetaminophen overdose (and nomogram to determine toxic 4 hour level).

Therese Lindberg

therese.lindberg@cambio.se

@CambioCDS

To calculate PO/IV NAC dosing for acetaminophen overdose (and nomogram to determine toxic 4 hour level).

FORMULA Actual body-weight dosing, starting with loading dose and then variable rates depending on PO vs. IV, as below. PO Loading dose is 140 mg/kg PO, then 17 more doses every 4 hours of 70 mg/kg PO. If patient vomits within 1 hour of dose, it must be repeated. IV Patients ≥41 kg: Loading Dose: 150 mg/kg in 200 mL of diluent administered over 60 minutes. Dose 2: 50 mg/kg in 500 mL of diluent administered over 4 hours. Dose 3: 100 mg/kg in 1000 mL of diluent administered over 16 hours. Patients 21 - 40 kg Loading Dose: 150 mg/kg in 100 mL of diluent administered over 60 minutes. Dose 2: 50 mg/kg in 250 mL of diluent administered over 4 hours. Dose 3: 100 mg/kg in 500 mL of diluent administered over 16 hours. Patients 5-20 kg: Loading Dose: 150 mg/kg in 3 mL/kg of body weight of diluent administered over 60 minutes. Dose 2: 50 mg/kg in 7 mL/kg of body weight of diluent administered over 4 hours. Dose 3: 100 mg/kg in 14 mL/kg of body weight of diluent administered over 16 hours.

1. Rumack BH, Peterson RC, Koch GG, Amara IA. Acetaminophen overdose: 662 cases with evaluation of oral acetylcysteine treatment. Arch Intern Med. 1981;141:380-5.

OBSERVATION.acetaminophen_overdose_nac_dosing.v0, OBSERVATION.body_weight.v2