It is unclear the incidence of hepatotoxicity in patients appropriately treated with timely N-acetylcysteine (NAC). In this case series, 77 patients with tylenol levels above the Rumack-Matthew nomogram recieved NAC within 8 hours for at least 21 hours. Despite appropriate treatment, 4 of them (5%) developed hepatotoxicity (including 1 death and 1 transplant). Appropriate and timely NAC treatment is not completely protective in tylenol overdoses, and transplant availability needs to be considered when admitting these patients (abstract).
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