Acetylcysteine (Page 4 of 5)

ACETAMINOPHEN ASSAY METHODOLOGY

Assay procedures most suitable for determining acetaminophen concentrations utilize high pressure liquid chromatography (HPLC) or gas liquid chromatography (GLC). The assay should measure only parent acetaminophen and not conjugated. The assay procedures listed below fulfill this requirement:

SELECTED TECHNIQUES (non inclusive)

HPLC:

1.
Blair D, Rumack, BH, Clin Chem, 1977; 23(4):743-745.
2.
Howie D, Andriaenssens Pl, Prescott LF. J. Pharm Pharmacol, 1977; 29(4):235-237. GLC
3.
Prescott LF. J. Pharm Pharmacol, 1971; 23(10):807-808. Colorimetric
4.
Glynn JP. Kendal SE, Lancet 1975; 1(May 17):1147-1148.

Supportive Treatment of Acetaminophen Overdose

1.
Maintain fluid and electrolyte balance based on clinical evaluation of state of hydration and serum electrolytes.
2.
Treat as necessary for hypoglycemia.
3.
Administer vitamin K1 if prothrombin time ratio exceeds 1.5 or fresh frozen plasma if the prothrombin time ratio exceeds 3.0.
4.
Diuretics and forced diuresis should be avoided.

DOSAGE GUIDE AND PREPARATION

Doses in relation to body weight are:

Loading Dose of Acetylcysteine **
**If patient weighs less than 20 kg (usually patients younger than 6 years), calculate the dose of acetylcysteine. Each mL of 20% acetylcysteine solution contains 200 mg of acetylcysteine. The loading dose is 140 mg per kilogram of body weight. The maintenance dose is 70 mg/kg. Three (3) mL of diluent are added to each mL of 20% acetylcysteine solution. Do not decrease the proportion of diluent.

grams

mL of 20%

mL of

Total mL of

Body Weight

Acetylcysteine

Acetylcysteine

Diluent

5% Solution

(kg)

(lb)

100-109

220-240

15

75

225

300

90-99

198-218

14

70

210

280

80-89

176-196

13

65

195

260

70-79

154-174

11

55

165

220

60-69

132-152

10

50

150

200

50-59

110-130

8

40

120

160

40-49

88-108

7

35

105

140

30-39

66-86

6

30

90

120

20-29

44-64

4

20

60

80

Maintenance Dose**

(kg)

(lb)

100-109

220-240

7.5

37

113

150

90-99

198-218

7

35

105

140

80-89

176-196

6.5

33

97

130

70-79

154-174

5.5

28

82

110

60-69

132-152

5

25

75

100

50-59

110-130

4

20

60

80

40-49

88-108

3.5

18

52

70

30-39

66-86

3

15

45

60

20-29

44-64

2

10

30

40

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