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Pediatric Rounds Review Questions
A Lethargic Infant with Vomiting

Answer 4

  1. Serum transaminase levels begins to rise within 18 to 24 hours of ingestion. Aspartate aminotransferase and alanine aminotransferase begin to rise 18 to 24 hours following ingestion and peak at 48 to 72 hours. The 4-hour acetaminophen level is the best predictor of hepatic toxicity. The Rumack-Matthew nomogram was developed for single acute exposures to N-acetyl-p-aminophenol (APAP). It is commonly used to predict risk of hepatotoxicity from serum APAP levels in cases of acute ingestion, but is not useful in cases of chronic toxicity. The parenteral form of NAC is not yet approved for routine use in United States. The clinical outcome of acute acetaminophen ingestion in children is very good. Few children develop hepatotoxicity, and only occasional cases progress to serious liver damage.

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