Rumack Mathew Normogram
Only suitable if
- time of ingestion is known
- no repeated ingestions
Indications for Acetylcystein
- Serum level above the “possible hepatic toxicity” line of the Rumack-Matthew nomogram
- Serum level unavailable within 8 hours post ingestion and Paracetamol ingestion suspected
- Time of ingestion is unknown and serum level is greater than 10 micrograms/ml
- Evidence of ANY hepatotoxicity with a history of Paracetamol ingestion
- Patient reports or clinician suspects repeated excessive Paracetamol ingestions
- Patient has risk factors for hepatotoxicity, and the serum level is greater than 10 mcg/ml
Dosage i.v.
300mg/kg over 20h
- bolus 150mg/kg over 15min
- then 50mg/kg over 4hrs
- then 100mg/kg over 16 hrs
Side effects
Anaphylaxis, rash, angioedema
Vomiting and flushing