Pedemy All toolsEnter weight, timing and level; the tool plots the level against the treatment line and gives NAC doses.
This calculator helps clinicians assess acetaminophen (paracetamol) overdose in children and adolescents. It plots the serum level on the Rumack–Matthew treatment line and calculates weight-based acetylcysteine (NAC) doses.
You enter weight and, if known, the amount taken to get a mg/kg dose. You then choose the type of ingestion: single with a known time, extended-release, or staggered, repeated or unknown time. For single ingestions the level is compared with the treatment line, which starts at 150 mcg/mL at 4 hours; the nomogram applies only from 4 to 24 hours. Levels can be entered in mcg/mL or µmol/L. Before 4 hours the tool advises waiting for a 4-hour level; beyond 24 hours, or for staggered ingestions, it advises NAC if the level is 10 mcg/mL or more or ALT/AST is raised.
The result gives a treatment decision, the nomogram chart, IV NAC as three bags (150, 50 and 100 mg/kg, total 300 mg/kg over 21 hours) or oral NAC, activated charcoal when timely, and transplant-referral markers. Sources are Rumack and Matthew 1975, the 2023 US and Canada consensus statement (Dart et al.), the 2006 AAPCC out-of-hospital guideline and the Acetadote prescribing information.
This tool uses the Rumack–Matthew 150 line: 150 mcg/mL at 4 hours after ingestion, falling over time. It applies only to a single acute ingestion with a reliable time, between 4 and 24 hours. A level on or above the line means start NAC.
Bag 1 is 150 mg/kg over 1 hour, bag 2 is 50 mg/kg over 4 hours and bag 3 is 100 mg/kg over 16 hours, for a total of 300 mg/kg over 21 hours. Weight is capped at 100 kg. The oral option is 140 mg/kg, then 70 mg/kg every 4 hours for 17 doses.
The tool advises referral for a level if the dose is 150 mg/kg or more (200 mg/kg in a healthy child under 6 with accidental ingestion), 7.5 g or more in total, intentional, or the amount is unknown.
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