Acute Acetaminophen Ingestion Management

Initial Assessment and Triage

For repeated supratherapeutic ingestions in children under 6 years, refer to emergency department immediately if they have ingested ≥200 mg/kg over a single 24-hour period, or ≥150 mg/kg per 24-hour period for the preceding 48 hours, or ≥100 mg/kg per 24-hour period for the preceding 72 hours or longer, as recommended by the American Academy of Pediatrics 1
The Rumack-Matthew nomogram is used to determine risk for hepatotoxicity, with levels plotting above the treatment line indicating the need for N-acetylcysteine (NAC) administration, according to the American College of Medical Toxicology 2

The American College of Medical Toxicology recommends administering NAC if the acetaminophen level plots above the treatment line on the Rumack-Matthew nomogram, with a total dosage of 300 mg/kg given intravenously as 3 separate doses over 21 hours 2
The American Academy of Pediatrics notes that the Rumack-Matthew nomogram only applies to single acute ingestions with a known time of ingestion, and that repeated supratherapeutic ingestions require different management approaches than single acute overdoses 1