title: Intravenous acetaminophen in the United States: iatrogenic dosing errors.
abstract: An intravenous formulation of acetaminophen was introduced to the United States in 2011. Experience from Europe indicates that serious dosing errors are likely to occur. Most events have involved a 10-fold dosing error in small children caused by calculating the dosage in milligrams, but then administering the solution in milliliters. The solution is 10 mg/mL; therefore, a 10-fold overdose occurs. Evaluation of overdose with the intravenous formulation is similar to oral overdose. A serum acetaminophen concentration should be drawn 4 hours after the infusion was started or as soon thereafter as possible. If the serum acetaminophen concentration plots above the treatment line on the Rumack-Matthew nomogram, treatment with acetylcysteine should be initiated. Health care providers are encouraged to contact their regional poison center (1-800-222-1222) so that dosing errors will be reported, and the experience with this new product can be accumulated.
authors.affiliation: Denver Health Medical Center, Rocky Mountain Poison and Drug Center, Denver, CO 80204, USA. richard.dart@rmpdc.org
authors.forename: Richard C
authors.initials: RC
authors.lastname: Dart
authors.forename: Barry H
authors.initials: BH
authors.lastname: Rumack
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000097:blood / Q000633:toxicity*; D000111:Acetylcysteine / Q000008:administration & dosage; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D054796:Drug Dosage Calculations; D062787:Drug Overdose / Q000453:epidemiology; D016166:Free Radical Scavengers; D006801:Humans; D007049:Iatrogenic Disease; D007223:Infant; D007262:Infusions, Intravenous / Q000009:adverse effects / Q000706:statistics & numerical data; D008508:Medication Errors / Q000706:statistics & numerical data*; D049451:Nomograms; D011039:Poison Control Centers; D014481:United States
chemical_list: D016166:Free Radical Scavengers; D000082:Acetaminophen; D000111:Acetylcysteine