Acetaminophen Level 

Acetaminophen Level 

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Therapeutic level: 10-25 mcg/mL

Toxic level: >200 mcg/mL

The Rumack-Matthew nomogram is used to interpret the acetaminophen level. Interpretation of a toxic level depends on the time since ingestion of acetaminophen.

Acetaminophen level is usually drawn after 4 hours of ingestion of acetaminophen.

Red top tube is preferred for collection of the blood sample. A 0.6-2-mL blood sample is collected and serum is separated from the blood. A repeat sample is obtained 3-4 hours after the first sample.

Acetaminophen toxicity is primary cause of drug overdose related–liver failure in the United States. [1] Acetaminophen is commonly used as an antipyretic and analgesic. The toxic dose is 150 mg/kg. Peak plasma concentrations are seen within 2 hours of ingestion. The half-life is usually 1-3 hours. [2] Acetaminophen is metabolized by several pathways—conjugated form, glucuronidation, sulfate, and other pathways.

Acetaminophen level is measured by an enzymatic method. In the presence of the enzyme arylacylamidase, acetaminophen is converted to p-aminophenol. In the presence of o -cresol and periodate, p-aminophenol is converted to a blue indophenol chromophore and the absorbance of light of the wavelength 615 nm is measured.

To diagnose acetaminophen overdose

To treat acetaminophen toxicity

To monitor patients with overdose

Gel tube should not be used to collect sample; gel leads to slow diffusion of the acetaminophen.

Liver toxicity usually peaks at 72 hours, but the serum level of liver enzymes has been described to start rising as early as 24 hours after the ingestion. [3, 4, 5]

A half-life of more than 4 hours is suggestive of hepatic damage/necrosis. However, it has also been seen in some patients with minimal liver toxicity. [6]

Jones CM, Mack KA, Paulozzi LJ. Pharmaceutical overdose deaths, United States, 2010. JAMA. 2013 Feb 20. 309(7):657-9. [Medline].

Slattery JT, Wilson JM, Kalhorn TF, Nelson SD. Dose-dependent pharmacokinetics of acetaminophen: evidence of glutathione depletion in humans. Clin Pharmacol Ther. 1987 Apr. 41(4):413-8. [Medline].

Singer AJ, Carracio TR, Mofenson HC. The temporal profile of increased transaminase levels in patients with acetaminophen-induced liver dysfunction. Ann Emerg Med. 1995 Jul. 26(1):49-53. [Medline].

Rumack BH. Acetaminophen overdose. Am J Med. 1983 Nov 14. 75(5A):104-12. [Medline].

James LP, Wells E, Beard RH, Farrar HC. Predictors of outcome after acetaminophen poisoning in children and adolescents. J Pediatr. 2002 May. 140(5):522-6. [Medline].

Gazzard BG, Widdop B, Davis M, Hughes RD, Goulding R, Williams R. Early prediction of the outcome of a paracetamol overdose based on an analysis of 163 patients. Postgrad Med J. 1977 May. 53(619):243-7. [Medline]. [Full Text].

Setu K Patolia, MD, MPH Assistant Professor of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Director of Interventional Pulmonary Services, Associate Program Director for Pulmonary and Critical Care Fellowship, St Louis University School of Medicine

Setu K Patolia, MD, MPH is a member of the following medical societies: American Association for Bronchology and Interventional Pulmonology, American College of Chest Physicians, American Thoracic Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Eric B Staros, MD Associate Professor of Pathology, St Louis University School of Medicine; Director of Clinical Laboratories, Director of Cytopathology, Department of Pathology, St Louis University Hospital

Eric B Staros, MD is a member of the following medical societies: American Medical Association, American Society for Clinical Pathology, College of American Pathologists, Association for Molecular Pathology

Disclosure: Nothing to disclose.

Dr. Maximo Mora

Acetaminophen Level 

Research & References of Acetaminophen Level |A&C Accounting And Tax Services
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