Master the board step 3

Emergency Medicine/Toxicology
Substance
Antidote
Digoxin
Ethylene glycol
Methanol
Methemoglobinemia
Neuroleptic malignant syndrome
Opiates
Organophosphates
Tricyclic antidepressants
Digoxin-binding antibodies
Fomepizole or ethanol
Fomepizole or ethanol
Methylene blue
Bromocriptine, dantrolene
Naloxone
Atropine, pralidoxime
Bicarbonate protects the heart
Acetaminophen
Clinical Course
··
First 24 hours: Nausea and vomiting, which resolve
··
48–72 hours later: Hepatic failure
Treatment
It is safe to give charcoal and N-acetyl cysteine (NAC). Know the following
about treating an acetaminophen overdose:
··
Give N-acetyl cysteine (NAC) to any patient with a possible overdose of a
toxic amount.
··
NAC is benign.
··
NAC is useful to prevent liver toxicity for up to 24 hours after the ingestion.
After 24 hours, there is no specific therapy to prevent or reverse the liver
toxicity of acetaminophen.
··
Vomiting patients can get NAC through the IV route.
If the amount of ingestion is equivocal, then get an acetaminophen level to
determine if there will be toxicity but do not wait for the results to give NAC
if the overdose is large.
··
10 g → toxic
··
15 g → fatal
The amounts needed for toxicity and fatality are lower if there is underlying
liver disease or alcohol abuse.
531