APAP Consensus 2023 — Management of Acetaminophen Poisoning in the US and Canada: A Consensus Statement
America's Poison Centers / AACT / ACMT / Canadian Association of Poison Control Centers, 2023
Use the treatment nomogram only for acute ingestions with a reliable time in the first 24 hours; treat repeated supratherapeutic ingestion by concentration/liver tests rather than the nomogram; do not stop acetylcysteine solely at a fixed 20-21 hour time point—continue until stopping criteria are met. High-risk ingestion (>=30 g or concentration on/above the high-risk line) warrants toxicology/poison-center consultation because no single intensified NAC regimen is established.
Clinical Context & Relevant Topics (2)
Disease ReferenceResuscitate first, identify toxidromes and ECG/acid-base threats, use toxin-specific antidotes, and escalate early to poison-center, extracorporeal, or ECLS support when physiology demands it.
Hyperammonemia, cytotoxic cerebral edema, balanced coagulopathy, N-acetylcysteine, 3% saline neuroprotection, CRRT ammonia clearance, and King's College transplant criteria.