The patient should receive NAC (N-acetylcysteine). NAC is almost 100% effective in preventing APAP toxicity if given within 8 hours of ingestion.

Remeber that NAC (mucomyst smells and tastes terrible. Have the patient drink from a straw, from a closed container. Reglan can be given IV (.1 to 1mg/kg) to help prevent emesis. If a patient does have emesis post ingestion it is recommended to repeat the full NAC dose.

Note: Charcoal therapy does not significantly effect NAC, therefore it is not necessary to increase the NAC dose if the patient has or already needs to have charcoal as well.

The loading dose for NAC in the 72 hour protocol is 140mg/kg, with subsequent doses being 70mg/kg for 17 doses. The NAC can be stopped at four hours if the level is in the safe range of the nomogram.