BACKGROUND: The Rumack-Matthew nomogram predicts the risk of hepatotoxicity following acute @entity1443 @entity1445 based on a serum concentration obtained   >= 4-hour post-ingestion. Some @entity1 with low-risk concentrations at 4 hours may have subsequent values indicating increased risk (above the nomogram treatment line), especially if coingestants that @entity344 are involved. The treatment line currently used to identify low risk @entity1 in the United States, Canada, and Australia begins at 150   mcg/mL (993    mol/L) and intersects at 18.75   mcg/mL (124.1    mol/L) 16 hours post-ingestion. OBJECTIVE: To determine the incidence of nomogram line crossing after acute @entity1445 of @entity1443 combination products containing an opioid or @entity16206 . METHODS: This was a prospective cohort study of hospitalized @entity1 reported to a @entity4968 ( @entity4968 ) after acute @entity1445 of a combination product containing an opioid or @entity16206 . If a 4-hour @entity1443 concentration was detectable but below the nomogram treatment line, the @entity4968 recommended repeat concentrations. @entity1 were entered into the study if at least one subsequent concentration was available. During follow-up calls hospital providers were queried regarding clinical features, treatment, and indicators of @entity99 . RESULTS: Over a 4-year period 76 @entity1 met entry criteria. 5/76 (6.6%) had measureable @entity1443 concentrations below the treatment line at or close to 4-hour post-ingestion followed by values above the line obtained at 6.5-12.5 hours. Four of the five were treated with @entity898 and none developed hepatotoxicity. Four of the five had clinical features reported to the @entity4968 suggesting @entity137 from the opioid or @entity16206 component. CONCLUSION: After acute @entity1445 of @entity1443 combination products, @entity1 with detectable but non-toxic 4-hour @entity1443 concentrations should have repeat concentrations obtained in a time frame that would allow providers to initiate @entity898 treatment, if needed, without undue delay.

Nomogram line crossing after XXXX combination product @entity1445 .

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients'] @entity16206 :: ('CHEBI:37956', 'Chemical') :: ['antihistamine'] @entity137 :: ('MESH:D064420', 'Disease') :: ['toxicity'] @entity344 :: ('MESH:D005767', 'Disease') :: ['slow gastrointestinal motility'] @entity4968 :: ('MESH:D011041', 'Disease') :: ['RPC', 'regional poison center'] @entity898 :: ('MESH:D000111', 'Chemical') :: ['acetylcysteine'] @entity1443 :: ('MESH:D000082', 'Chemical') :: ['acetaminophen'] @entity99 :: ('MESH:D056486', 'Disease') :: ['liver injury'] @entity1445 :: ('MESH:D062787', 'Disease') :: ['overdose']
@entity1443 :: (MESH:D000082,Chemical) :: ['acetaminophen']
