[##]-year-old
[male/female] presents with history and exam consistent with acetaminophen
overdose [as a suicide attempt/additional].
Initial considerations in this patient
included acetaminophen intentional and accidental overdose, other intentional
ingestions and co-ingestions including salicylates, alcohol, toxic alcohols,
opioids, benzodiazepines, anticholinergic medications, and antidepressant
medications including tricyclic antidepressant (TCA) among others, other self-injury,
and other infectious and toxicologic etiologies among others.
Patient presented with [suspected/reported]
overdose of acetaminophen [## hours/days] prior to presentation. Patient felt to have [no indication for
intubation or more aggressive airway management on presentation/indication for
intubation due to altered mental status].
Patient noted to be [unstable with appropriate resuscitation initiated/hemodynamically
stable] on presentations. Gastrointestinal
decontamination with activated charcoal [felt to not be indicated given
presentation over 3 hours from reported/suspected ingestion/administered in
patient presenting within 3 hours from reported/suspected ingestion]. Initial labs were obtained including an ethyl
alcohol level, salicylate level, [others] and liver function tests, which were
[noted to be unremarkable/notable for elevated hepatic enzymes/specify]. A 12-lead EKG was obtained [with no evidence
of acute ischemia, infarction or other QRS, ST, or T wave changes associated
with tricyclic antidepressant overdose/notable for specify abnormality].
An [initial/4-hour] acetaminophen level was
obtained and [noted to be elevated based on Rumack-Matthew nomogram/noted to be
elevated in the setting of unknown time of ingestion]. Treatment with N-acetylcysteine (NAC) initiated
via [oral/intravenous] route along with supportive care as noted above. Patient felt to have [no] indication for transfer to transplant center by King's Criteria at this time.
Case discussed with [ICU team/admitting
hospitalist and Poison Control] with plan for admission to the [ICU/telemetry unit/etc.]. Planned admission and treatment [was/was not]
discussed with the patient [who demonstrated understanding and agreement with
plan/who is involuntary for admission at this time/due to altered mental
status].
https://www.mdcalc.com/kings-college-criteria-acetaminophen-toxicity
https://edsmartchart.blogspot.com/2020/06/decision-rule-kings-college-criteria.html
http://www.emdocs.net/toxcard-acetaminophen-toxicity-and-management/
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