Special Medications

-Activated Charcoal 30-100 gm doses, remove via NG suction prior to acetylcysteine.

-Acetylcysteine (Mucomyst, NAC) 5% solution loading dose 140 mg/kg via NG tube, then 70 mg/kg via NG tube q4h x 17 doses OR acetylcysteine 150 mg/kg IV in 200 mL D5W over 15 min, followed by 50 mg/kg in 500 mL D5W, infused over 4h, followed by 100 mg/kg in 1000 mL of D5W over next 16h. Complete all NAC doses even if acetaminophen levels fall below toxic range.

-Phytonadione 5 mg IV/IM/SQ (if INR increased).

-Fresh frozen plasma 2-4 U (if INR is unresponsive to phytonadione).

-Trimethobenzamide (Tigan) 100-200 mg IM/PR q6h prn nausea

10. Extras: ECG. Nephrology consult for hemodialysis or charcoal hemope-

rfusion.

11. Labs: CBC, SMA 7&12, LFTs, INR/PTT, acetaminophen level now and in

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