Acetaminophen Treatment Nomogram

Abstract

To the Editor: The acetaminophen treatment nomogram is widely used as a guideline for acetylcysteine therapy in patients with an acetaminophen overdose1. However, the potential toxicity of acetaminophen may be underestimated by the nomogram in patients with underlying hepatic dysfunction or long-term alcohol use2. We recently treated a 21-year-old woman who had attempted suicide by ingesting 25 g of acetaminophen. She had no history of any hepatic abnormality but had consumed large amounts of ethanol for a long period. She presented to her local hospital three hours after ingestion of the acetaminophen. The serum acetaminophen level was 151 . . .