Can acetaminophen concentrations < 100 mcg/mL obtained between 1-4 hours after acute ingestion accurately predict a nontoxic 4-hour concentration? NO!
Despite a high negative predictive value, a new study found there are still cases with toxic concentrations after 4 hours despite earlier levels < 100 mcg/mL.
The Rumack-Matthew nomogram is to be utilized starting at 4 hours after an acute acetaminophen ingestion. Unless the concentration is zero, a second level must be drawn at 4 hours if an earlier one is positive.
References
Froberg BA, et al. Negative predictive value of Acetaminophen concentrations within four hours of ingestion. Acad Emerg Med 2013;20(10):1072-5. [PMID 24127715]
Rhyee SH. Early serum acetaminophen levels: how soon is too soon? Acad Emerg Med 2013;20(10):1070-1. [PMID 24127714]
