Treatment of APAP Toxicity With IV and Oral NAC 2008-2011

Treatment of Acetaminophen Toxicity With Intravenous vs. Oral N-acetylcysteine: A Retrospective Review

Retrospective chart review of patients who receive N-acetylcysteine for Acetaminophen(APAP) toxicity to assess length of oral vs. IV treatment and the effect of a Clinical Pharmacology and Toxicology division in the management of APAP ingestions.

Inclusion Criteria:

• Admitted to CHMCA between June 1, 2008 to June 30, 2011
• Qualifying ICD-9 diagnosis code for the following APAP overdose situations: poisoning, accidental, suicide attempt, therapeutic use, assault, and undetermined (965.4, E850.4, E950.0, E935.4, E962.0, E980.0)
• Serum APAP concentration above the possible hepatotoxic line on the Rumack-Matthew's nomogram if obtained > 4 hours post ingestion
• Between ages 0-21 years on date of admission
• Acute APAP ingestion

Exclusion Criteria:

• Serum APAP concentrations not actually documented
• Did not receive the oral or IV NAC treatment
• Preexisting liver disease such as cirrhosis or hepatitis C
• Patient > 21 years of age on the date of admission
• Chronic APAP ingestion