The antidote is N-aceycysteine, which must be given promptly. he drug is thought to increase glutathione levels, which aid metabolism of the toxic metabolite, N-acetyl-pbenzoquinoneimine. he need for treatment is based on projections of possible plasma hepatotoxic levels as a function of the time from acute ingestion. For this, many poison control centers use the nomogram established by Rumack and Matthew (1975). A plasma level is measured 4 hours after ingestion, and if the level is > 150 1g/mL, treatment is given (Smilkstein, 1988). If plasma determinations are not available, empirical treatment is given if the ingested amount exceeded 7.5 g. An oral loading dose of 140 mg/kg of N-acetylcysteine is followed by 17 maintenance doses of 70 mg/kg every 4 hours for 72 hours of total treatment time. Both the oral and an equally eicacious IV dosing regimen have been reviewed by Hodgman and Garrard (2012). he drug has been reported to reach therapeutic concentrations in the fetus (Wiest, 2014).
After 14 weeks' gestation, the fetus has some cytochrome P450 activity necessary for metabolism of acetaminophen to the toxic metabolite. Riggs and colleagues (1989) reported follow-up data from the Rocky Mountain Poison and Drug Center in 60 women sufering overdose. he likelihood of maternal and fetal survival was better if the antidote was given soon after overdose. At least one 33-week fetus appears to have died as a direct result of hepatotoxicity 2 days after maternal ingestion. In another case, Crowell and associates (2008) reported a case of acetaminophen overdose at 32 weeks' gestation. The woman had taken 9.75 grams of acetaminophen approximately 1.5 hours prior to arrival. With treatment, the patient survived and went on to deliver a healthy term neonate.
This benign lesion of the liver is characterized in most cases by a well-delineated accumulation of normal but disordered hepatocytes that surround a central stellate scar. hese usually can be diferentiated from hepatic adenomas by magnetic resonance (vIR) or computed tomographic (CT) imaging. Except in the rare situation of unremitting pain, surgery is rarely indicated, and most women remain asymptomatic during pregnancy. In one review of 20 cases in Germany, no woman had related complications during pregnancy (Rifai, 2013). hree women showed 20-percent tumor growth; in 10 patients, the tumor decreased in size; and the remaining seven were unchanged across pregnancy. Ramirez-Fuentes and associates (2013) studied 44 lesions with MR imaging in 30 women. Of the lesions, 80 percent were unchanged in size, and most of the remainder decreased in size. They concluded that size changes were unrelated to pregnancy, combination oral contraceptive (COC) use, or menopause. Notably, this lesion is not a contraindication to estrogen-containing contraceptives (Chap. 38, p. 692).