When is a pregnancy test indicated in the workup of acetaminophen toxicity/poisoning?

Updated: Jan 17, 2020
  • Author: Susan E Farrell, MD; Chief Editor: Michael A Miller, MD  more...
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Answer

In females of childbearing age, obtain a serum concentration of human chorionic gonadotropin (hCG). [31] If that is positive, ultrasound can confirm gestational age of the fetus. Acetaminophen crosses the placenta, and the fetal liver is able to elaborate the hepatotoxic metabolite of APAP, N-acetyl-p-benzoquinone imine (NAPQI), by 14 weeks’ gestation. Delayed antidotal treatment in pregnant women has been associated with fetal loss, so antidotal therapy should be initiated as soon as acetaminophen ingestion is diagnosed in pregnant patients.

Arterial blood gas and serum lactate concentrations should be followed. A pH of less than 7.3 or a lactate concentration greater than 3.5 after fluid resuscitation are laboratory indicators predictive of mortality. [24]


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