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APAP OD Treatment
Lecture 6
| Question | Answer |
|---|---|
| Treatment Plan | Emergency stabilization , Decontamination (don’t worry about it b/c of antidote) , Antidote , Enhancing elimination , Liver transplant |
| APAP Treatments (3) | Emergency stabilization , Decontamination , Acetylcysteine (^-acetylcysteine, NAC, Mucomyst , Acetadote ) |
| Acetylcysteine (NAC) Available Forms | Acetadote – IV , Mucomyst – Inhalation/Oral (generic) |
| Muco myst | Inhalation/Oral (generic) |
| Acetadote | IV |
| NAC MOA My notes | Precursor for glutathione synthesis , Substitute for glutathione , Substrate for sulfation , Direct hepato protective |
| When NAC most effective | within first 8 hours |
| Acetylcysteine Effectiveness | Equally effective if given within the first 8 hours , Effectiveness decreases after 8 hours , ? Effective > 24 hours , Some benefit late in fulminant hepatic fail |
| NAC Indications | Acute overdose [APAP] above treatment line Elevated AST/ALT or [APAP] if time unknown , Chronic overdose High risk based on symptoms and/or [APAP], AST/ALT |
| NAC Indications Acute OD - time known | [APAP] |
| NAC Indications Acute OD - time unknown | Increased AST/ALT (>50IU/L) Increased (APAP] (> lOmcg/mL) |
| NAC Indications Chronic OD | High-risk , Symptoms , [APAP] . AST/ALT |
| NAC Oral dose | Load followed by maintenance |
| NAC Oral dose Load | 140 mg/kg load |
| NAC Oral dose Maintenance | 70 mg/kg q4 hours for 17 doses |
| NAC Oral administration | Dilute to 5% solution to avoid gastric irritation |
| Oral Acetylcysteine (NAC) Notes Dose | 140 mg/kg load M 70 mg/kg q4 hours X 17 Shorter course may be used |
| Oral Acetylcysteine (NAC) Notes Administration | Dilute to 5% solution to avoid gastric irritation Cold, sweet, acidic beverage to disguise taste - FRESCA™ NG/NJ Smaller more frequent doses |
| NAC Oral SEs | Primarily GI |
| IV Acetylcysteine (NAC) Adults Loading Dose | 150 mg/kg in 200mL D5W over 60 min |
| IV Acetylcysteine (NAC) Adults Loading Dose J Maintenance Dose | 50 mg/kg in 500mL D5W over 4 hours 4 , 100 mg/kg in 100mL D5W over 16 hours |
| IV Acetylcysteine (NAC) Children | 20kg, < 40 kg Decrease fluid volume by 50% < 20 kg Fluid adjusted by body weight (see ???) |
| NAC Pediatric considerations | Risk for anaphylactoid reactions , Higher risk in asthamtics , Hyponatremia in children if pediatric fluid guidelines not adhered |
| NAC Monitoring therapy | Check AST/ALT and [APAP] at end of infusion or oral therapy Continue therapy if detectable APAP or AST/AST increasing |
| Ensuring Optimal NAC Therapy Obtain | APAP, AST & ALT concentrations at end of infusion |
| Ensuring Optimal NAC Therapy Continue NAC if | detectable APAP or rising AST/ALT (16-hour bag) |
| Ensuring Optimal NAC Therapy At risk for longer duration of therapy: | Late presenters , , Supra-therapeutic or unknown ingestion , , Diphenhydramine |
| APAP Liver transplant Kings College criteria pH | < 7.3 |
| APAP Liver transplant Kings College criteria lactate | > 3 mmol/L |
| APAP Liver transplant Kings College criteria INR | >6.5 |
| APAP Liver transplant Kings College criteria Scr | >3.39mg/dL |
| APAP Liver transplant Kings College criteria encephalopathy | Grade III or higher |
Created by:
pberriochoa
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