IBCC Episode 26 - Acetaminophen Toxicity

In this episode of The Internet Book of Critical Care Podcast, Josh and Adam discuss acetaminophen poisoning, covering epidemiology, pharmacokinetics, clinical evolution, patient evaluation, decontamination, and treatment with N-acetylcysteine (NAC). They highlight the differences between acute and chronic poisoning, risk factors, and the importance of glutathione. They review the classic four stages of acetaminophen toxicity and emphasize the limitations of the Rumack-Matthew nomogram, advocating for erring on the side of administering NAC due to its safety profile. The hosts discuss IV versus oral NAC, management of anaphylactoid reactions, and special considerations for pregnant patients, massive acetaminophen poisoning requiring hemodialysis, and patients with hepatic or renal failure, including transfer criteria for transplant centers.