Download Acetaminophen Overdose Orders

PLACE LABEL HERE
ACETAMINOPHEN OVERDOSE
ORDERS
The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.
Initial all handwritten order modifications and the bottom of each page when indicated (multipage).
1. Diagnosis Admit as Inpatient _________________________________________________(reason for admission)
& Status: Place in Observation _______________________________________________(reason for observation)
Unit:  ICU  IMCU/PCU  Medical Floor (with Telemetry)  Medical Floor (No Telemetry)
Consults:
Mental Health consult  Other: ______________________________________________________
Suicide Precautions
Diagnostics:
STAT labs (if not done in ED): acetaminophen level, PT/INR, and liver function tests
Daily labs: acetaminophen level, PT/INR, and liver function tests daily x 3 days
6. Vitals q ________ hrs
7. Intake and Output q _______ hrs
8. Foley Catheter Removal and Urinary Retention Standing Orders (form # 31620), initiate if patient has urinary retention
or difficulty voiding
9. Initiate Venous Thromboembolism (VTE) Prophylaxis Orders (form # 33058)
10. Actual weight of patient: ______ kg (Required)
11. Diet: _________________________________________________________________________________________
12. Nutrition Supplement Protocol (form # 31417), initiate if patient meets criteria
13. Activity: _______________________________________________________________________________________
SCHEDULED MEDICATIONS
14. IVF: ___________________________________________IV at ____________ ml/hr
15.
Acetylcysteine Therapy:
 Oral: Mucomyst (acetylcysteine) 140 mg/kg po or NG tube, then 4 hrs after loading dose, give 70 mg/kg po q
4 hrs x 17 doses (18 total doses). May dilute in soft drinks.
 IV: IV formulation reserved for patients unable to tolerate oral acetylcysteine
Acetadote (acetylcysteine) infusion: Total infusion time = 21 hours
For patients < 40 kg or those requiring fluid restriction, notify pharmacy to reduce the total volume and
recalculate rates to avoid fluid overload
2.
3.
4.
5.
16.
Weight (kg) round
up to next 5 kg
weight
Acetadote Loading Dose
150 mg/kg in D5W 250 ml
over 60 minutes
Acetadote SECOND Dose 50
mg/kg in D5W 500 ml over 4
hours
Acetadote THIRD Dose 100
mg/kg in D5W 1,000 ml over
16 hours
40 kg
45 kg
50 kg
55 kg
60 kg
65 kg
70 kg
75 kg
80 kg
85 kg
90 kg
95 kg
100 kg
105 kg
> 110 kg MAX
6,000 mg
6,750 mg
7,500 mg
8,250 mg
9,000 mg
9,750 mg
10,500 mg
11,250 mg
12,000 mg
12,750 mg
13,500 mg
14,250 mg
15,000 mg
15,750 mg
16,500 mg
2,000 mg
2,250 mg
2,500 mg
2,750 mg
3,000 mg
3,250 mg
3,500 mg
3,750 mg
4,000 mg
4,250 mg
4,500 mg
4,750 mg
5,000 mg
5,250 mg
5,500 mg
4,000 mg
4,500 mg
5,000 mg
5,500 mg
6,000 mg
6,500 mg
7,000 mg
7,500 mg
8,000 mg
8,500 mg
9,000 mg
9,500 mg
10,000 mg
10,500 mg
11,000 mg
 Lovenox (enoxaparin) 40 mg SQ q 24 hrs at 1700; if CrCl < 30, give 30 mg SQ q 24 hrs
Copy to pharmacy
*3-20583*
Order writer’s initials _______
FORM 3-20583 REV. 12/2013
Page 1 of 2
PLACE LABEL HERE
ACETAMINOPHEN OVERDOSE
ORDERS
17.
 Colace (docusate) 100 mg po bid
Copy to pharmacy
*3-20583*
Order writer’s initials _______
FORM 3-20583 REV. 12/2013
Page 2 of 2
PLACE LABEL HERE
ACETAMINOPHEN OVERDOSE
ORDERS
The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.
Initial all handwritten order modifications and the bottom of each page when indicated (multipage).
PRN MEDICATIONS See policy 520-06 for range orders and pain intensity guidelines.
18.
Severe pain: 
Morphine 1-4 mg IV q 3 hrs prn (DC if epidural or PCA is ordered)
or  DC Morphine. Dilaudid (HYDROmorphone) 0.5-1 mg IV q 3 hrs prn (DC if epidural or PCA is ordered)
19.
Moderate pain:
 Toradol (ketorolac) 30 mg IV (or IM if no IV access) q 6 hrs prn (15 mg if > 65 y/o old
or < 50 kg) or 10 mg po q 6 hrs prn (maximum combined duration of IV and po
Toradol {ketorolac} is 5 days)
 Other: _____________________________________________________________
20.
Mild pain/temp >100.5F/HA:  Ibuprofen 200-400 mg po q 4 hrs prn, may use elixir
21.
Nausea/Vomiting:
Zofran (ondansetron) 4 mg IV or po q 6 hrs prn
 If N/V persists, add Reglan (metoclopramide) 10 mg IV q 6 hrs prn (5 mg if > 65 y/o)
and/or  If N/V persists, add Phenergan (promethazine) 12.5-25 mg po or per rectum q 4 hrs prn
22.
Indigestion: Maalox XS (aluminum/magnesium/simethicone) 30 ml po four times daily prn
23.
Constipation: Milk of Magnesia (MOM) 30 ml po daily prn
24.
Anxiety:
25.
Itching: Benadryl (diphenhydramine) 25-50 mg po or 12.5-25 mg IV q 6 hrs prn
Ativan (lorazepam) 0.5 - 1 mg po or IV q 8 hrs prn.
or  DC Ativan. Give Xanax (alprazolam) 0.25 - 0.5 mg po q 6 hrs prn.
ADDITIONAL ORDERS:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________
Date
___________________
Time
_________________________________
Physician Signature
___________
PID Number
Copy to pharmacy
FORM 3-20583 REV. 12/2013
Page 3 of 2