Emergency Medicine Cases
Ep 180 Acetaminophen Poisoning – Pitfalls in Assessment and Management
User's personalized AI podcast notes AI-generated based on their snips
AI-generated based on their snips
1. Blood work abnormalities are critical in determining the management of acute drug overdose cases, especially concerning the stages of acetaminophen toxicity, where acetaminophen levels should be high and liver function tests should be normal. Patients with an increase in transaminases by the 24-hour mark are at risk for liver damage from the overdose.
2. False positive elevations in acetaminophen levels can result from bilirubin interference and elevated INR results that can be temporary and later normalized. It's essential to consider other indicators of health, such as the levels of bilirubin, to avoid potential misdiagnoses.
3. Acetaminophen overdose cases can include misinterpretations of liver enzymes, resulting from false-positive levels, high bilirubin, and only having ALT instead of AST. While a delay in hepatic failure cases can cause elevated bilirubin, it's critical not to miss potential cases due to limited test results.
4. Toxicologists use ALT and AST levels to monitor patients with an acetaminophen overdose. Patients should be monitored with serial ALT levels to catch any delayed hepatic toxicity, while AST provides a better indication of patient recovery.
5. Hyperphosphatemia is an excellent prognostic test for patients with acetaminophen overdose, while low serum phosphate levels suggest a higher chance of survival. Although the hyperphosphatemia can be useful, some pitfalls can affect the data's interpretation that would help assess the patient's condition and acute liver failure risk.
6. After an acetaminophen exposure, draw an acetaminophen level after 4 hours and use the Matthew Rheumach nomogram to determine treatment. Early activated charcoal use is crucial, especially with pediatric patients who may have accidentally ingested the drug.
7. For massive acetaminophen ingestion, the patient requires prompt treatment. The level of toxicity defines the timing of the treatment, especially those coming in later who require immediate attention.
8. Dialysis is not a standard of care for acetaminophen poisoning but indicated where it's causing toxicity, such as lactic acidosis or depressed level of consciousness. Hemepisol shows potential benefits as a more effective treatment for acetaminophen overdose than NAC and provides different benefits.
9. Fumepisol shows promising results and may be more important in the future than NAC, given its potential for blocking the formation of NAP-key and inhibiting proteins that cause cellular necrosis.
