Rumack–Matthew Nomogram
The Rumack–Matthew nomogram, also known as the acetaminophen nomogram, is an acetaminophen toxicity nomogram. It plots serum (blood), serum concentration of acetaminophen against the time since ingestion, in order to predict possible hepatotoxicity, liver toxicity and allow a clinician to decide whether to proceed with N-Acetylcysteine (NAC) treatment. It is a logarithmic graph starting 4 hours after ingestion; at this time the absorption of acetaminophen is considered likely to be complete. This nomogram allows for timely management of an acetaminophen overdose. Generally, a serum plasma concentration (APAP) of 140–150 μg/mL (or mg/L) at 4 hours post-ingestion indicates the need for NAC treatment. This nomogram is not used alone if the patient has altered mental status or if the history is not reliable; rather, an additional line should be drawn and plotted to see if the slope of the line remains at or above the nomogram. Additionally, a formal half-life may also be determin ...
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