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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Rumack’s publications, visit PubMed. He is a retired professor emeritus of pediatrics at the University of Colorado School of Medicine. If above treatment line, NAC is indicated.

Well absorbed from the small intestine Peak concentration hours post ingestion 30 mins for liquid Small volume of distribution 0.

Treatment with NAC indicated scetaminophen Acetaminophen Toxicity and Management. Commence NAC infusion 3. Critical Actions Serum acetaminophen concentration should be sent in all patients presenting with intentional overdose or those using excessive amounts of acetaminophen containing products. Loves the misery of alpine climbing and working in austere environments.

If paracetamol concentration result can be determined before 8 hourswait, plot against the nomogram and treat as appropriate. NAC treatment should be initiated within 8 hours post-ingestion to decrease risk of hepatotoxicity.

Acetaminophen Toxicity

Paracetamol has many varied presentations, you need to be a true jedi master of the risk assessment. These images are a random sampling from a Bing search on the term “Acetaminophen Toxicity. Emergency Physician working in Vancouver. In patients presenting hours post-ingestion, start NAC while awaiting the acetaminophen concentration; once this is resulted, NAC can be continued or discontinued depending on the level. If results are abnormal continue 20 hour NAC infusion. Related Topics in Analgesic Medications.


By using this site, you agree to the Terms of Use and Privacy Policy. Remember, majority of APAP absorption occurs by 4 hours this may not be true with overdose. Key Points to remember: Rumack-Matthew Nomogram for Acetaminophen 1.

Acehaminophen Figure 2 below.

Give activated charcoal if they present within 2 hours 2. You might be interested in Serum acetaminophen concentration should be sent in all patients presenting with intentional nomogrsm or those using excessive amounts of acetaminophen containing products. Nelson LS, et al Eds. An informed decision should be made when stopping NAC, which requires assessing that the risk acetaminopheh developing toxicity is low [APAP] is undetectable, ASTs are normaland any toxicity that occurred has been resolved.

Rumack-Matthew nomogram

If NAC is given within 8 hours in non-massive exposures and a 20 hour infusion is completed no other blood tests are required. Normally paracetamol is conjugated with glucuronide and excreted in the urine.

Serum concentrations above the treatment line indicate the need for N-acetylcysteine NAC therapy. NAC is only indicated if the patient is symptomatic nausea, vomiting, abdominal pain or encephalopathy or a detectable paracetamol concentration or raised hepatic transaminases.


It is highly recommended to consult with a acetaminnophen control center or medical toxicologist when considering the discontinuation of acetylcysteine prior to the conclusion of a full course of therapy. Your email address will not be published.

Her weight is 54 kg. If patient vomits within 1 hour of dose, it must be repeated. Acetaminophen overdose disorderParacetamol overdose disorderoverdose acetaminophenacetaminophen overdoseoverdose paracetamolacetaminophen overdosesparacetamol overdoseParacetamol overdoseAcetaminpohen overdose.

There I said it.

Acetaminophen Overdose and NAC Dosing – MDCalc

Obtain a 4-hour level or later, up to 24 hours to get estimated acetaminopjen absorption that is, if time of ingestion is certain. But what about extended release, what xcetaminophen they have co-ingestants, what if they took multiple does of paracetamol at different times? Pharmacology – Analgesic Medications Pages.

Retrieved from ” https: If the patient has a staggered overdose throughout the day over 8 hourse. Access 22 Aug This was published in Med treatment and more Treatment. Consists of 3 components Loading dose: