James et al evaluated pediatric patients exposed to acetaminophen. They identified laboratory tests which can help to identify a patient at low risk for acetaminophen hepatotoxicity. The authors are from the University of Arkansas in Little Rock.
Patient selection: acetaminophen ingestion with serum concentration above the toxicity line of the nomogram, with arrival within 24 hours of the ingestion
Criteria for low risk of acetaminophen toxicity - all of the following:
(1) normal prothrombin time at 48 hours after ingestion (also for INR)
(2) normal serum AST at 48 hours after ingestion
(3) normal serum ALT at 48 hours after ingestion
These indicate the need to observe the child for at least 48 hours post-ingestion.
All 3 values being normal within 24 hours after the ingestion does not exclude hepatotoxicity.
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