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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It identifies patients at very low risk of developing hepatotoxicity after acetaminophen overdose and who do not require NAC. Diagram acetaminophhen the MJA: Patients 21 – 40 kg Loading Dose: NAC treatment should be initiated within 8 hours post-ingestion to decrease risk of hepatotoxicity.

N Engl J Med. Analysis of the National Multicenter Study.

A formal half life may also be determined. Unknown time of ingestion: Actual body-weight dosing, starting with loading dose and then variable rates depending on PO vs.

Start NAC and time anchor the paracetamol concentration to Algorithm of the month Algorithm for the Management of Atrial Fibrillation. A year-old woman is brought into the ED by family members after she reported ingesting 35 Tylenol tablets Extra-Strength 2 hours ago. Serious to lethal hepatotoxicity Acetaminophen Overdosage Hepatoxic dose: This project is rolling and you can submit an idea or write-up at any time! There are no randomised control trials to support this and exact practise may change in the future.

She should be started on NAC.

Lexicomp Online [online database]. Search other sites for ‘Acetaminophen Toxicity’.

Tarascon Adult Emergency Pocketbook. Patients who ingest over 30g, or the paracetamol concentration is greater than double the nomogram line have an increased risk of hepatotoxicity.


If above treatment line, NAC is indicated. Guidelines for the management of paracetamol poisoning in Australia and New Zealand — explanation and elaboration. 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.

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

Either the patient refuses to tell you, you have doubts about the timing or they are in a coma and paracetamol is detectable, start NAC.

We are acetaminopphen to believe that paracetamol overdose is easy, you take a four hour concentration, mark it on the nomogram and either treat or not. Each country has different nomograms and units — make sure you are using the correct one and correct scale From the Australian Society of Emergency Medicine Paracetamol Poster.

TOXCard: Acetaminophen Toxicity and Management

Our goal is to inform the global EM community with timely and high yield content about what providers like YOU are seeing and doing everyday in your local ED. May be given PO or IV.

New Guidelines for the management aacetaminophen paracetamol poisoning in Australian and New Zealand. If results are abnormal continue 20 hour NAC infusion.

Rumack-Matthew nomogram – Wikipedia

Absence of formulations or coingestants that alter absorption and bowel motility e. See Figure 2 below. This nomogram is not used alone if the patient has altered mental status or if the history is not reliable. Rumack’s publications, visit PubMed. Beyond 24 hours the patient should be symptomatic therefore, start NAC if the patient has nausea, vomiting, abdominal pain or encephalopathy.


Equally do not discharge the symptomatic patient, you may have miss timed the point of ingestion or the patient may have lied to you about time or co-ingestants. Lexi-Comp Accessed Aug Presentation within 24 hours: If a paracetamol concentration cannot be determined within 8 hours, start NAC until the results are available.

Paracetamol • Life in the Fast Lane • LITFL • Medical Blog

The Rumack-Matthew nomogram is the most sensitive nomotram prediction tool in medical toxicology. Diagram from MJA article: Archives of Internal Medicine. Nomogdam complains of nausea and vomiting and admits this was an attempt to harm herself. In these cases, start or continue NAC until the risk assessment can be refined using further biochemical parameters and paracetamol concentrations.

Med treatment and more Treatment. There are immediate- and extended-release formulations. Acute, single ingestions where entire ingestion occurs within an 8-hour period.

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. Beyond 24 hours, symptoms should be evident nausea, vomiting, abdominal pain or encephalopathy.