The Rumack-Matthew nomogram (the acetaminophen toxicity nomogram or acetaminophen nomogram), is used to interpret serum. The Rumack-Matthew nomogram uses the serum acetaminophen concentration, in relation to the time after ingestion, to assess potential. The Rumack-Matthew nomogram, also known as Rumack-Matthews nomogram or the acetaminophen nomogram is an acetaminophen toxicity nomogram.

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If above treatment line, NAC is indicated.

TOXCard: Acetaminophen Toxicity and Management

NAC treatment should be initiated within 8 hours post-ingestion to decrease risk of hepatotoxicity. This nomogram is not used alone if the patient has altered mental status or if the history is not reliable.

If the patient has a staggered overdose throughout the day over 8 hourse. The Rumack-Matthew nomogram is the most sensitive risk prediction tool in medical toxicology.

Acetaminophen Overdose and NAC Dosing – MDCalc

NAC continues until the paracetamol concentration is undetectable and hepatic transaminases are stable or falling and the patient is clinically improving. When to Initiate Treatment: Remember, majority of APAP absorption occurs by 4 hours this may not be true with overdose.

If results are abnormal continue 20 hour NAC infusion. New Guidelines for the management of paracetamol poisoning in Australian and New Zealand. An acetaminophen concentration obtained prior to 4 hours post-ingestion cannot be plotted on the Rumack-Matthew nomogram, and only confirms acetaminophen exposure, not toxicity. If both levels are below the line and not increasing then NAC can be discontinued.


Rumack-Matthew nomogram

It is a logarithmic graph starting not directly from ingestion, but from 4 hours post ingestion after absorption is considered likely to be complete.

We are led to believe that paracetamol overdose is easy, you take a four hour concentration, mark it on the nomogram and either treat or not. Management If known time of ingestion Obtain acetaminophen concentration at 4 hours post-ingestion or as soon as possible thereafter.

About the Creator Dr. Give activated charcoal if they present within acetqminophen hours 2. These images are a random sampling from a Bing search on the term “Acetaminophen Toxicity. Pharmacology – Analgesic Medications Pages.

Paracetamol is a hard overdose to understand. When to use the Rumack-Matthew nomogram: Efficacy declines after this point. If you time anchor to 3pm you may have a lower concentration and underestimate the overdose.

It identifies patients at very low risk of developing hepatotoxicity after acetaminophen overdose and who do not require NAC. What if the patient present at 8 hours, 12 hours or 24 hours. If above treatment line, NAC should be initiated within 8 hours post-ingestion.

Views Read Edit Qcetaminophen history. Back Links pages that link to this page. This allows for the worst case scenario. Below are the most common presentations and how to manage them: Please fill out required fields.

Screen with labs APAP concentration, hepatic function tests, renal function tests, coagulation studies, blood gasassess patient risk factors and clinical features. Enter your email address and acetaimnophen send you a link to reset your password. The Rumack-Matthew nomogramalso known as Rumack-Matthews nomogram or the acetaminophen nomogram is an acetaminophen toxicity nomogram plotting serum concentration of acetaminophen against the time since ingestion in an attempt to prognosticate possible liver toxicity as well as allowing a clinician to decide whether to proceed with N-Acetylcysteine NAC treatment or not.


Lexicomp Online [online database]. To save favorites, you must log in. Creating an account is free, easy, and takes about 60 seconds. Rumack-Matthew Nomogram for Acetaminophen 1. Accessed 22 Aug This project acetamknophen rolling and you can submit an idea or write-up at any time!

Concepts Injury or Poisoning T SnomedCT English Acetaminophen overdose disorderParacetamol overdose disorderoverdose acetaminophenacetaminophen overdoseoverdose paracetamolacetaminophen overdosesparacetamol overdoseParacetamol overdoseAcetaminophen overdose Spanish sobredosis de paracetamol trastornosobredosis de paracetamol. Critical Actions Serum acetaminophen concentration should be sent in all patients presenting with intentional overdose or those using excessive amounts of acetaminophen containing products.

In patients presenting hours post-ingestion, start NAC while awaiting the acetaminophen concentration; once this is resulted, NAC can be continued or discontinued depending on the level. This was published in