Acetaminophen on the NCLEX
Acetaminophen: max dose, hepatotoxicity, N-acetylcysteine antidote, alcohol interaction.
Acetaminophen is the most-used analgesic and the most common cause of acute liver failure in the US. The NCLEX tests max dose, hepatotoxicity, and the antidote.
Dosing
Adult max: 4 g/24 hours (3 g if liver impairment or chronic alcohol use). Peds: 10-15 mg/kg q4-6h, max 5 doses/24h.
Hepatotoxicity
Dose-related. Risk increased with chronic alcohol use, malnutrition, liver disease. Symptoms 24-72h after overdose: RUQ pain, N/V, elevated LFTs.
Antidote
N-acetylcysteine (NAC), oral or IV. Most effective within 8 hours of ingestion. Continue regardless of presentation time in suspected overdose.
Teaching
Read OTC labels, acetaminophen is in many cold/flu products. Don't combine without checking total dose.
Frequently asked
How many extra-strength tablets is toxic?
Variable. Single dose >7.5 g in adult typically triggers treatment. Get level at 4 hours, plot on nomogram.
Liver disease, max dose?
Generally 2-3 g/24h. Avoid in severe disease.
Quick check
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