Know When High Acetylcysteine Doses May Be Used

You may be asked about high-dose acetylcysteine for patients with “massive” acetaminophen overdose.

There’s no set definition for massive. But it’s often at least 30 g of ingested acetaminophen...or above the “300-line” of the Rumack-Matthew toxicity nomogram at least 4 hours after ingestion.

The concern is that the typical IV acetylcysteine treatment... 150 mg/kg over 1 hour, then 50 mg/kg over 4 hours, then 100 mg/kg over 16 hours...may fall short in patients with a massive overdose.