Acetaminophen - a common analgesics easily available without doctors prescription in our country - overdosed patient is one of most commonly encountered in the ED. But, acetaminophen is relatively safe drug and treatment of acetaminophen overdosage has been well established. But for the proper management of these patients, two following restrictions should be overcome. The first, serum acetaminophen level should be available immediately for proper disposition of the patients. The second one is the use of the antidote (NAC:N-acetyl cysteine, Mucomyst®) to the potentially toxic patients without delay and adequate dosage and route of administration of the NAC should be familiar to the emergency physician. Except a few hospital, serum acetaminophen level is not available in our country. This pitfall can make emergency physician delay the use of the NAC or misuse of the NAC. To overcome of this pitfall, we reviewed -patients who admitted in our hospital due to acetaminophen overdosage from July 1. 1993 to June-30. 1995. Total 18 patients enrelled in our study, 4 male, mean age 25.5 years old, and mean -ED presentation time after ingestion was 6.25 hours. Acetaminophen single ingestion was 14 cases and mixed ingestion was 4 cases. With the exception of the one case who ingested 3g of acetaminophen, ´all patients received 72 hour oral NAC as an antidote for poisoning of acetaminophen. Both NAC and MDAC(multiple dose activated charcoal) was used in 8 cases. {Serum acetaminophen level was obtained in 12 cases,. `Three patients had showed hepatotoxicity-liver enzyme (SGOT/SGPT) level above 200 lU-recovered during hospitalization.´ No fatal hepatotoxicity was noted in our study. Fourteen adjustment disorder, one personality disorder and three major depression was
their final psychiatric diagnosis. Their mean hospital day was 7.2 days. In the conclusion, as the efficacy of NAC as an antidote decreases after 8 hours, treatment must be started immediately following all potentially toxic dose of acetaminophen. Administration can be stopped if the acetaminophen concentration is below the treatment line but it is important to avoid potentially fatal delay.
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