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The Rumack-Matthew nomogram (the acetaminophen toxicity nomogram or acetaminophen nomogram), is used to interpret serum. The Rumack-Matthew nomogram uses the serum acetaminophen concentration, in relation to the time after ingestion, to assess potential. The Rumack-Matthew nomogram, also known as Rumack-Matthews nomogram or the acetaminophen nomogram is an acetaminophen toxicity nomogram.

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About the Creator Dr. Symptoms and Signs Course: Equally do not discharge the symptomatic patient, you may have miss timed the point of ingestion or the patient may have lied to you about time or co-ingestants. This project is rolling and you can submit an idea or write-up at any time! Diagram from MJA article: NAC continues until the paracetamol acetaminpohen is undetectable and hepatic transaminases are stable or falling and the patient is clinically improving.

Acetaminophen Overdose and NAC Dosing – MDCalc

Related Bing Images Extra: Unknown time of ingestion: Views Read Edit View history. Activated charcoal can also be considered up to 4 hours after time of ingestion in massive paracetamol overdose. Noomgram — majority is absorbed within 2 hours. If results are abnormal continue 20 hour NAC infusion.


From Wikipedia, the free encyclopedia. Start NAC and time anchor the paracetamol concentration to Chronic overdose occurs with repeated supratherapeutic ingestions greater than an 8-hour period.

Presentation within 24 hours: When to use the Rumack-Matthew nomogram: May be given PO or IV. The principal investigators of the study request that you use the official version of the modified score here. Emergency Physician working in Vancouver. But what about extended release, what if they have co-ingestants, what if they took multiple does of paracetamol at different times?

TOXCard: Acetaminophen Toxicity and Management

It is a logarithmic graph starting not directly from ingestion, but from 4 hours post ingestion after absorption is considered likely to be complete. If above treatment line, NAC is indicated.

Archives of Internal Medicine. Mar 29th, Maryam Abdrabbo categories: Subcategory of ‘Diagnosis’ designed to be very sensitive Rule Out. Diagram from the MJA: Key Points to remember: About the Creator Barry H. Well absorbed from the small intestine Peak concentration hours post ingestion 30 mins for liquid Small volume of distribution 0.


Lexicomp Online [online database]. NAC is continued beyond the 20 hours infusion until paracetamol is undetectable.

Accessed 22 Aug If both levels are below the line and not increasing then NAC can be discontinued. Beyond 24 hours, symptoms should be evident nausea, vomiting, abdominal pain or encephalopathy. Or create a new account it’s free.

The EM Educator Series: When to Initiate Treatment: Sorry, your blog cannot share posts by email. Pharmacology – Analgesic Medications Pages. Commence NAC infusion 3. Lowers the threshold for N-Acetylcysteine use baseline glutathione deficiency Dehydration, Fastin g or Malnutrition Alcohol Abuse Axetaminophen Concurrent use of other medications Isoniazid reports of hepatotoxicity with concurrent Acetaminophen 3.

Encephalopathy of any degree if discussions are needed with the patient it is best to make these referrals early before the patient becomes too confused.