Management of paracetamol poisoning. A review of the medical literature showed the painkiller poses the risk forthree rare but potentially fatal skin disorders: Stevens-Johnson syndrome, toxic epidermal necrolysis, and acute generalized exanthematous pustulosis. Imaging: No specific imaging is required. Bateman DN. As a thank-you for using our site, here's a discounted rate for renewal or upgrade. Supply parents and caregivers with contact information for their local Poison Control Center and the telephone number for the toll-free Poison Help Line (1-800-222-1222). Medscape Medical News. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. Acetaminophen or paracetamol increase the pain-relieving effects of oxycodone.
Access up-to-date medical information for less than, Domino, Frank J., et al., editors. Preferably, caregivers should use the dropper or syringe-measuring tool that accompanies the product.
2006 Jan. 30(1):1-5. See Workup. In one study, the APACHE II score was found to be accurate, but cumbersome to apply. Empirically give NAC in patients presenting near 8 hours while waiting for labs. This time frame can be extended if the patient has ingested an acetaminophen-based sustained-release medication or if the ingestion includes agents that are known to slow gastric emptying. Please confirm that you would like to log out of Medscape. This medication is also prescribed for treating heart/blood vessel disorder, stomach disorder and headache. Clinical evidence of end-organ toxicity is often delayed 24-48 hours after an acute ingestion of acetaminophen. A patient-tailored N-acetylcysteine protocol for acute acetaminophen intoxication. Accessed: October 2, 2021. [5]. The index of the coding manual contains two tables to help facilitate locating certain diagnostic codes. 1998 Feb. 26(2):279-84. Safety and efficacy of intravenous N-acetylcysteine for acetaminophen overdose: analysis of the Hunter Area Toxicology Service (HATS) database. You are being redirected to Overdose with acetaminophen can occur at any age. Look for signs of hepatotoxicity: hepatomegaly and RUQ pain. Undefined. Lowes R. Acetaminophen Poses Risk for Rare but Fatal Skin Reactions. Accessed: October 2, 2021. Smilkstein MJ, Knapp GL, Kulig KW, Rumack BH. [QxMD MEDLINE Link]. Children in this age group are less susceptible to hepatotoxicity from acute acetaminophen poisoning. Signs and symptoms of poisoning develop over the first 24 hours following large ingestions. From: Rumack BH, Matthew H. Acetaminophen Poisoning and Toxicity. Generally, the elimination half-life of acetaminophen is 2 hours (range 0.9-3.25 h). Laboratory results are usually unremarkable at this time. ED - Domino,Frank J, It is prescribed for nervousness and tension that falls under menopausal symptoms. Acetaminophen, also known as paracetamol (outside the United States and Canada) and by its chemical name, N-acetyl-p-aminophenol (APAP), is available in more than 200 OTC and prescription medications, either as a single agent or in combination with other pharmaceuticals. NAPQI has an extremely short half-life and is rapidly conjugated with glutathione, a sulfhydryl donor, and is then renally excreted. N-acetylcysteine (NAC), or acetylcysteine, is an extremely effective antidote for acetaminophen-induced hepatotoxicity due to an acute overdose, especially if administered within 8-10 hours after ingestion. This medication is a nonsteroidal anti-inflammatory drug (NSAID), prescribed for fever, pain and inflammation in the body. 2016; Accessed: October 2, 2021. [QxMD MEDLINE Link]. Michael J Burns, MD Instructor, Department of Emergency Medicine, Harvard University Medical School, Beth Israel Deaconess Medical Center, Michael J Burns, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine, Timothy E Corden, MD Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin, Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society, Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT Associate Clinical Professor, Department of Surgery/Emergency Medicine and Toxicology, University of Texas School of Medicine at San Antonio; Medical and Managing Director, South Texas Poison Center, Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT is a member of the following medical societies: American Academy of Emergency Medicine, American College of Clinical Toxicologists, American College of Emergency Physicians, American College of Medical Toxicology, American College of Occupational and Environmental Medicine, Society for Academic Emergency Medicine, and Texas Medical Association, Halim Hennes, MD, MS Division Director, Pediatric Emergency Medicine, University of Texas Southwestern Medical Center at Dallas, Southwestern Medical School; Director of Emergency Services, Children's Medical Center, Halim Hennes, MD, MS is a member of the following medical societies: American Academy of Pediatrics, Jeffrey R Tucker, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center, John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals, John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists, Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference. Acetaminophen exposure alone resulted in 198 deaths, and acetaminophen combinations resulted in 99 deaths. Fulminant hepatic failure occurs in <1% of adults and is very rare in children <6 years of age. Note: Your username may be different from the email address used to register your account. Minimum toxic doses of acetaminophen for a single ingestion, posing significant risk of severe hepatotoxicity, are as follows: The clinical course of acetaminophen toxicity generally is divided into four phases. 2015 May-Jun. Peak plasma levels occur within 4 hours after ingestion of an overdose of an immediate-release preparation. 2015 May-Jun. Zyoud SH, Awang R, Sulaiman SA, Al-Jabi SW. Impact of serum acetaminophen concentration on changes in serum potassium, creatinine and urea concentrations among patients with acetaminophen overdose. 2008 Jul. The FDA is also addressing other changes to acetaminophen-based medications, including the following: In 2011, the FDA announced that it was asking manufacturers of prescription acetaminophen combination products to limit the maximum amount of APAP in these products to 325 mg per tablet, capsule, or other dosage unit. [Full Text]. Right upper quadrant pain and hepatomegaly may become evident. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvODIwMjAwLW92ZXJ2aWV3, Children: 150 mg/kg; 200 mg/kg in healthy children aged 1-6 years, Patients may be asymptomatic or report anorexia, nausea or vomiting, and malaise, Physical examination may reveal pallor, diaphoresis, malaise, and fatigue, Patients develop right upper quadrant abdominal pain, anorexia, nausea, and vomiting, Right upper quadrant tenderness may be present, Tachycardia and hypotension may indicate volume losses, Some patients may report decreased urinary output (oliguria), Patients have continued nausea and vomiting, abdominal pain, and a tender hepatic edge, Hepatic necrosis and dysfunctionmay manifest asjaundice, coagulopathy, hypoglycemia, and hepatic encephalopathy, Acute kidney injury develops in some critically ill patients, Patients who survive critical illness in phase 3 have complete resolution of symptoms and complete resolution of organ failure, Liver function tests (alanine aminotransferase [ALT], aspartate aminotransferase [AST]), bilirubin [total and fractionated], alkaline phosphatase), Prothrombin time (PT) with international normalized ratio (INR), Kidney function studies (electrolytes, BUN, creatinine), Lipase and amylase (in patients with abdominal pain), Human chorionic gonadotropin (hCG) (in females of childbearing age), Salicylate level (in patients with concern of co-ingestants), Arterial blood gas and ammonia (in clinically compromised patients), Urinalysis (to check for hematuria and proteinuria), ECG (to detect additional clues for co-ingestants), Inability to tolerate oral NAC because of emesis refractory to proper use of antiemetics, Metabolic acidosis, persistent after fluid resuscitation, Tablets (dissolvable (Meltaways) and chewable), Paraffin-base rectal suppositories (FeverAll). In the United States, acetaminophen toxicity has replaced viral hepatitis as the most common cause of acute hepatic failure and is the second most common cause of liver failure requiring transplantation. Medscape Medical News. This medication is a nonsteroidal anti-inflammatory drug (NSAID), prescribed for relieving pain and reduces swelling (inflammation) and fever. [1] It has an excellent safety profile when administered in proper therapeutic doses, but hepatotoxicity can occur after overdose or when misused in at-risk populations. Necrosis primarily occurs in the centrilobular (zone III) region, owing to the greater production of NAPQI by these cells. Blood lactate as an early predictor of outcome in paracetamol-induced acute liver failure: a cohort study.
From 2008 to 2012, about 49% of unintentional, According to 2008 to 2012 data from the American Association of Poison Control, there were an average 111,632 nationwide, An estimated average of 10% of these events resulted in liver toxicity and 1% resulted in death (. With toxic ingestions, AST, ALT, and bilirubin levels begin to rise in stage 2 and peak in stage 3. Behavioral health evaluation for intentional ingestions, Child abuse reporting if neglect led to overdose. OCallaghan C, Graudins A, Wong A. True or false? An adult takes more than 4,000 mg of acetaminophen in 24 hours. Tsai CL, Chang WT, Weng TI, Fang CC, Walson PD. Therapeutic pediatric doses are 10 to 15 mg/kg q46h, not to exceed 5 doses in 24 hours or 75 g/kg/day. Accidental poisoning (unintentional ingestion) can occur in toddlers and young children with unsupervised access to medications. A diagnostic serum concentration is helpful, even in the absence of clinical symptoms, because clinical symtpoms are delayed. Analysis of the national multicenter study (1976 to 1985).
Bateman DN, Dear JW, Thanacoody HK, Thomas SH, Eddleston M, Sandilands EA, et al. McNeil Consumer Healthcare. T1 - Acetaminophen Poisoning Clinical policy: critical issues in the management of patients presenting to the emergency department with acetaminophen overdose. A therapeutic misadventure typically occurs in children younger than 1 year, when their caregivers give incorrect doses of a medication containing acetaminophen. Crowell C, Lyew RV, Givens M, Deering SH. Acetaminophen poisoning is an acute illness. If a sustained-released product has been ingested, obtain two serum, For chronic toxicity or patients who present 24 hours postingestion, treat based on clinical effects, LFTs, and the, Liver function tests: alanine transaminase (ALT), aspartate transaminase (AST), prothrombin time (PT)/international normalized ratio (INR), bilirubin, lactate dehydrogenase (LDH). 2008 Dec. 84(6):684-90. [QxMD MEDLINE Link]. James LP, Capparelli EV, Simpson PM, Letzig L, Roberts D, Hinson JA, et al. Clin Toxicol (Phila). A 5-Minute Clinical Consult subscription is required to, http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/Guidances, A disorder characterized by hepatic necrosis following large. Additional labs: electrolytes, glucose, BUN, creatinine, urinalysis, urine drug screen (UDS), serum alcohol, and salicylate. In the United States, acetaminophen toxicity has replaced viral hepatitis as the most common cause of acute liver failure. [8, 9], Unrelated to dosage, another announcement from the FDA in 2013 advised that anyone who has a skin reaction, such as the development of a rash or blister, while taking acetaminophen should stop using the drug and seek immediate medical care. 2019 Aug. 46:423-430. [QxMD MEDLINE Link]. :[Full Text]. Presentation of symptoms varies and is divided into 4 stages (3): Primary questions should focus on what was ingested (extended release, hydrocodone-acetaminophen, co-ingestants, etc. [Full Text]. Federal Register-- Docket Number FDA-2012-D-0529. Therapy with NAC has been shown to decrease mortality rates in late-presenting patients with fulminant hepatic failure, even in the absence of measurable serum APAP levels. Discharges following toxicity decreased from 119.8 per 100,000 in 2009 to 108.6 per 100,000 in 2011 (1).Prevalence. Medscape Education, Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021, 20021011549-overviewDiseases & Conditions, encoded search term (Acetaminophen Toxicity) and Acetaminophen Toxicity, Botulinum Toxin Injections in Plastic Surgery, Pathophysiology and Etiology of Lead Toxicity, EMA Panel Recommends DPD Testing Prior to Fluorouracil Treatment, Treating Older AML Patients and Managing Unique Toxicities, How to Optimize Shared Decision-Making in Psoriatic Arthritis. Guidelines for the Management of Acetaminophen Overdose. Toxicol Appl Pharmacol. 1. In adults, the minimum toxic dose of acetaminophen for a single ingestion is 7.5-10 g. In children, the minimum toxic dose of APAP for a single acute ingestion is 150 mg/kg. 342:d2218. 32(9):1125-7. NAC is approved for both oral and IV administration. Recovery may be prolonged, but is typically complete and without long-term sequelae. For children younger than 12 years and/or less than 50 kg in weight, the maximum daily dose is 75 mg/kg, with a recommended dosage of 10-15 mg/kg every 4-6 hours as needed and no more than 5 doses per 24-hour period. In their retrospective cohort study of 334 adult patients with a discharge diagnosis of acetaminophen-induced liver failure, the presence of hypoglycemia increased the odds of reaching the composite endpoint (death or transplantation) by 3.39-fold. [Full Text]. In fact, the American Association of Poison Control Centers (AAPCC) reports that acetaminophen is one of the most common pharmaceuticals associated with both intentional and unintentional poisoning and toxicity. Download the 5-Minute Clinical Consult app by Unbound Medicine, 2. 2011 Apr 19. Pediatric patients younger than 6 years appear to fare better than adults after acute acetaminophen poisoning, perhaps owing to their greater capacity to conjugate APAP through sulfation, enhanced detoxification of NAPQI, or greater glutathione stores. Spiller HA, Winter ML, Klein-Schwartz W, Bangh SA. This means the certain diseases and conditions have to be reported to: Publishes diagnostic and procedure coding competencies for outpatient service and diagnostic coding for billing and reporting requirements for physician billing. Therapeutic levels are 5-20 g/mL (33-132 mol/L). [QxMD MEDLINE Link]. In an attempt to decrease this potential for acetaminophen toxicity in the United States, a number of pharmaceutical regulatory changes have been introduced. 1994 May. This combination medication contains barbiturate, central nervous system stimulant, analgesic, antipyretic and anti-inflammatory agents, prescribed for relieving tension headaches. 2018 Jan 5. Similar enzymatic reactions occur in extrahepatic organs, such as the kidney, and can contribute to some degree of extrahepatic organ dysfunction. Marked liver enzyme elevations which usually peak at this point; prolonged PT/INR; typically negative, Multiorgan failure and death most commonly occur in this stage, Possible recovery stage in patients with resolving stage 3 symptoms. ER -, Your free 1 year of online access expired. [22]. Acetaminophen is primarily metabolized by conjugation in the liver to nontoxic, water-soluble compounds that are eliminated in the urine. Chyka PA, Seger D, Krenzelok EP, Vale JA. Use of substances that induce the activity of the APAP-metabolizing CYP enzymes may increase the risk of morbidity by enhancing the production of NAPQI (see Etiology). Compromised nutritional status (eg, from prolonged fasting, eating disorders, Repeated administration of proper doses at shortened time intervals, Young age (as due to caregiver mismanagement), Arterial pH less than 7.30 after fluid resuscitation, Prothrombin time (PT) greater than 1.8 times control or greater than 100 seconds, or International Normalized Ratio (INR) greater than 6.5. Finally, elevations in blood lactate levels have been studied as prognostic indicators after acute acetaminophen overdose. Select Try/Buy and follow instructions to begin your free 30-day trial. [5] Acetaminophen toxicity is the most common cause of hepatic failure requiring liver transplantation in the United Kingdom. 383 (9918):697-704. However, as no controlled studies have supported an alternative pediatric-specific therapy, treatment in children is the same as in adults. IV NAC is generally preferred in pregnancy due to greater bioavailability (3). Available at http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm165107.htm. Available at http://www.fda.gov/Drugs/DrugSafety/ucm363041.htm#. 2014 Feb 22. A prospective evaluation of the effect of activated charcoal before oral N-acetylcysteine in acetaminophen overdose. In addition, McNeil pharmaceuticals (makers of the brand name Tylenol products) sponsors a toll-free number through the Rocky Mountain Poison and Drug Center, 1-800-525-6115, available 24 hours/d, for further consultation and guidance. Since NAC is a precursor of glutathione, it increases the concentration of glutathione available for the conjugation of NAPQI. Evaluate patients with evidence of organ failure, increased LFTs, or coagulopathy for emergency liver transplant (ELT) at a transplant center. Outpatient management is adequate for nontoxic accidental ingestions. [15]. Older patients (eg, teenagers and adults) may overdose with intent to do self-harm. The antidote for acetaminophen poisoning, NAC, is theorized to work through a number of protective mechanisms. Public health problem of liver injury related to the use of acetaminophen in both over-the-counter (OTC) and prescription (RX) products. Acetaminophen and codeine is a combination of non-opiate and opioid (opium-like sleep inducing) analgesics used to treat patients with fever, headache and helps to suppress the cough symptoms by acting on the cough center in the brain. The medication blocks certain chemicals in the nervous system thereby helps to relieve the signs and symptoms. U.S. Food and Drug Administration. Concepts and controversies. It helps for managing postoperative pain and also for additional pain relief while undergoing painful procedures. DB - 5minute For patient education information, see Tylenol PoisoningandPoison Proofing Your Home. Spiller HA, Krenzelok EP, Grande GA, Safir EF, Diamond JJ.
Ann Emerg Med. Numerous formulations and preparations are readily available, including the following: Acetaminophen toxicity occurs relatively frequently. The modified Rumack-Matthew nomogram (the acetaminophen toxicity nomogram or acetaminophen nomogram) is used to interpret plasma acetaminophen concentrations relative to time post ingestion to assess for the hepatotoxicity risk in patients. [QxMD MEDLINE Link]. In 2009, the US Food and Drug Administration (FDA) required that nonprescription and prescription acetaminophen-containing medications provide information regarding the risks of acetaminophen-induced hepatotoxicity. The FDA-approved regimen for oral administration of NAC (Mucomyst) is as follows: The IV formulation of NAC (Acetadote) is commonly used in many institutions for the treatment of acetaminophen ingestion. Efficacy of activated charcoal administered more than four hours after acetaminophen overdose. Laboratory abnormalities typically resolve. Health and Human Services. Because of absorption differences, weight-based rectal suppository dosing for children is higher, at 15-20 mg/kg per dose, using the same time interval as for oral acetaminophen. Was the ingestion intentional or accidental? Educate parents/caregivers during well-child visits regarding appropriate OTC dosing and medication storage. In chronic acetaminophen toxicity, the role of fasting, reduced glutathione stores, and enhanced metabolism remains unclear. Keep dose of acetaminophen 3,000 mg/day in seniors and in patients with liver disease and/or alcohol abuse disorders (3).Pediatric ConsiderationsHepatic damage after ingestion of toxic acetaminophen doses can be less severe in young children, potentially because they have more stores of glutathione (3).Pregnancy ConsiderationsThere is an increased incidence of spontaneous abortion in pregnant patients with acetaminophen poisoning, especially with overdose at an early gestational age. [14] See Treatment and Medication. [13] The evaluation and treatment approach for an IV acetaminophen overdose is similar to that of an oral overdose. If you need further assistance, please contact Support. Consider hospitalization for toxic ingestions with vital instability and/or laboratory abnormalities. [Full Text]. [16, 17, 18] The FDA addressed the possibility of removing acetaminophen from some popular analgesic combination products (eg, hydrocodone-acetaminophen [Vicodin]) and/or lowering the maximum cited daily dose of acetaminophen. Complete recovery with early therapy is possible and more likely in stage 4 of toxicity (, 10% of adult patients with severe liver complications develop necrosis, hepatic encephalopathy, or require transplant (, Hepatic failure is rare in children <6 years of age (. (Eds.). The Rumack-Matthew nomogram interprets the acetaminophen concentration (in micrograms per mL), in relation to time (in hours) after ingestion, and is predictive of possible hepatotoxicity after single, acute ingestions of acetaminophen. [2]. 1975 (55)871-876. The following concerns were also addressed: In 2011, the FDA asked manufacturers of prescription acetaminophen combination products to limit the maximum amount of acetaminophen in these products to 325 mg per tablet, capsule, or other dosage unit.7In 2014, the FDA issued a statement advising doctors to stop prescribing combination prescription pain relievers that contain more than 325 mg of acetaminophen per tablet, capsule, or other dosage unit. Curr Med Res Opin. Patients with acetaminophen concentrations below the possible" line for hepatotoxicity on the Rumack-Matthew nomogram may be discharged home after they are medically cleared. [10, 11]. Schmidt LE, Dalhoff K. Serum phosphate is an early predictor of outcome in severe acetaminophen-induced hepatotoxicity. With severe poisonings, PT/INR rise in parallel with LFT changes. The serum concentration peaks 1-2 hours post ingestion. Brooks M. FDA Asks Docs to Limit Acetaminophen in Prescription Meds. 2021 Jan. [QxMD MEDLINE Link]. [Full Text]. If using oral NAC, dilute with a beverage to increase palatability. Levine M, Stellpflug SJ, Pizon AF, Peak DA, Villano J, Wiegand T, et al. Risk prediction of hepatotoxicity in paracetamol poisoning. [QxMD MEDLINE Link]. Co-ingestion with drugs that delay gastric emptying (eg, opiates, anticholinergic agents) or ingestion of an acetaminophen extended-release formulation may result in peak serum levels being achieved more than 4 hours post ingestion. Federal Register. Evaluation of an Alternative Intravenous N-Acetylcysteine Regimen in Pediatric Patients. ET - 27 Clin Toxicol (Phila). In the United States, acetaminophen toxicity has replaced viral hepatitis as the most common cause of acute hepatic failure and is the second most common cause of liver failure requiring transplantation. PO NAC may cause significant nausea and vomiting due to its sulfur content and is often poorly tolerated; consider a nasogastric tube. Therefore, to identify a patientwho maybe at risk of hepatoxicity, the clinician should determine the time(s) of ingestion, the quantity, and the formulation of acetaminophen ingested. Reduction of adverse effects from intravenous acetylcysteine treatment for paracetamol poisoning: a randomised controlled trial. Consider an arterial blood gas (ABG): Anion-gap metabolic acidosis due to accumulation of 5-oxoproline may rarely be seen. Previously, mainly two concentrations of OTC acetaminophen formulations were available: 80 mg/0.8 mL (Infant Concentrated Drops) and 160 mg/5 mL (Children's Liquid Suspension or Syrup). 2002 Sep. 36(3):659-65. 2020 Dec. 58 (12):1360-1541. 80 (1):45-50. Assessment of the clinical use of intravenous and oral N-acetylcysteine in the treatment of acute acetaminophen poisoning in children: a retrospective review. Obtain a pregnancy screen in females (urine or serum) as it can influence management. February 26, 2016; Accessed: October 2, 2021. As a reference, the 24-hour dosage of acetaminophen for children should not exceed 75 mg/kg/d. All material on this website is protected by copyright, Copyright 1994-2022 by WebMD LLC. Serper M, Wolf MS, Parikh NA, et al. Organ-Specific Warnings; Internal Analgesic, Antipyretic, and Antirheumatic Drug Products for Over-the-Counter Human Use; Final Monograph. In healthy children aged 1-6 years, medical toxicologists recommend increasing this threshold to 200 mg/kg. In adults, an acute ingestion of more than 150 mg/kg or 12 g of acetaminophen is considered a toxic dose and poses a high risk of liver damage. A number of screening measurements have been studied as prognostic indicators after acetaminophen ingestion. Symptoms may develop gradually in those with a history of long-term ingestion near supratherapeutic doses. Acetaminophen and hydrocodone is a combination of non-opioid and narcotic or sleep-inducing agents used to treat moderate to severe pain associated with inflammation. January 14, 2014; Accessed: October 2, 2021. Br J Clin Pharmacol. NAC is maximally hepatoprotective when administered within 8 hours of an acute acetaminophen ingestion. Additional recommended studies are as follows: In patients with mental status changes, strongly consider serum ammonia levels and CT scanning of the brain. This medication is a nonsteroidal anti-inflammatory drug (NSAID), prescribed for postoperative pain in adults. Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose. Immediately contact a local Poison Control Center for recommendations. Chiew AL, Gluud C, Brok J, et al. 1994 Mar. Risk factors, clinical presentation, and outcomes in overdose with acetaminophen alone or with combination products: results from the Acute Liver Failure Study Group. This combination also helps in reducing fever, mild to moderate pain, and improves blood flow by relaxing muscle contractions.
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