EM Ottawa - By Alexandra Hamelin - Juyl 15, 2021
TAKE HOME POINTS:
- The appropriate dosing of AC is an AC-to-drug ratio of 10:1. This strategy works especially well for smaller ingestions. If the amount that the patient ingested is unknown, a 1g/kg dose of AC is appropriate.
- AC can be given up to 2-4 hours post-ingestion if the benefits outweigh the risks. Later administration beyond 4 hours can be considered if other factors exist such as serious toxicity, modified-release product, and delayed gastric emptying.
- MDAC should be considered if a patient has ingested a life-threatening amount of drug known to undergo enterohepatic circulation (i.e. carbamazepine, phenobarbital, theophylline)
- AC can be considered up to 2 hours after acetaminophen overdose. AC should be more strongly considered in polypharmacy ingestions, and especially in massive acetaminophen ingestion.
- The combined approach of AC and WBI is still often employed in dangerous overdoses of sustained-release medications. One approach, based largely on expert opinion, is to give a first dose of AC, wait for the AC to act alone, administer WBI, and then give a second dose of AC 1-2 hours later.