Assessment

Antidote in Acetaminophen Overdose

• Assess type, amount, and time of acetaminophen ingestion. Assess plasma acetaminophen levels. Initial levels are drawn at least 4 hr after ingestion of acetaminophen. Plasma level determinations may be difficult to interpret following ingestion of extended-release preparations. Do not wait for results to administer dose

» IV: Assess for anaphylactoid reaction. Erythema and flushing are common, usually occurring 30–60 min after initiating infusion, and may resolve with continued administration. If rash, hypotension, wheezing, dyspnea occur, initiate treatment for anaphylaxis (antihistamine and epinephrine). Acetylcysteine infusion should be interrupted until symptoms resolve and carefully restarted. If anaphylactoid reaction recurs, discontinue acetylcysteine and use alternative form of treatment

» Monitor AST, ALT, and bilirubin levels along with prothrombin time every 24 hr for 96 hr in patients with plasma acetaminophen levels indicating potential hepatotoxicity

» Monitor cardiac and renal function (creatinine, BUN), serum glucose, and electrolytes. Maintain fluid and electrolyte balance, correct hypoglycemia, and administer vitamin K₁ or fresh frozen plasma or clotting factor concentrate if prothrombin time ratio exceeds 1.5 or 3, respectively

» Assess patient for nausea, vomiting, and urticaria. Notify physician if these occur

• Assess respiratory function (lung sounds, dyspnea) and color, amount, and consistency of secretions before and immediately following treatment to determine effectiveness of therapy

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