A case of acetaminophen overdose in pregnancy treated with gastric lavage and N-acetylcysteine under monitoring based on Rumack-Matthew nomogram

Abstract

Background：Acetaminophen（APAP）is widely used during pregnancy due to its perceived safety. However, overdose can result in severe hepatotoxicity in both the mother and fetus. The Rumack-Matthew nomogram is a standard tool to assess hepatotoxic risk and to implement accurate N-acetylcysteine（NAC）therapy, but its application in pregnant patients is rarely reported.

Case Presentation：A woman in her second trimester （20 weeks’ gestation） ingested 15 g of APAP and was transferred to the emergency department one hour later. She underwent endotracheal intubation and gastric lavage, followed by NAC administration based on her actual body weight （87 kg）. Serial measurements of serum APAP concentration every 4 hours demonstrated a typical decline below the treatment line on the Rumack-Matthew nomogram. No hepatic dysfunction was observed. Obstetric monitoring revealed no fetal abnormalities. The patient was discharged on hospital day 7. She subsequently delivered a healthy infant at term. At 2 years of age, the child showed no signs of neurodevelopmental delay.

Conclusion：In this case of second-trimester APAP overdose, gastric decontamination and repeated NAC therapy were effective. The Rumack-Matthew nomogram was useful in guiding therapeutic monitoring, even during pregnancy.