Cyclic vomiting and cannabinoid hyperemesis syndromes repeatedly bring patients through the doors of the ED
In contrast, acute ingestion of alcohol at the time of paracetamol overdose is protective against the development of toxicity *
After two years, homocysteine levels in those who received a supplement with 200 mcg of folic acid, 10 mcg of B 12 , and 10 mg of B 6 had decreased by 2.4 mol/L, or about 17%, more than placebo, and bone mineral density loss had slowed in a subset of participants with low baseline B 12 status
doi: 10.1111/j.1600-065X.2008.00607.x 93 CondeelisJPollardJW
It also helps protect against oxidative stress by conjugating to GSH, neutralizing free radicals
(Of course, when it gets hard is when you have no clue as to when the patient actually ingested the acetaminophen - either because they cant or dont want to tell you This makes using the nomogram rather difficult!) The tl;dr of Acetaminophen Toxicity and Overdose Acetaminophen remains one of the most accessible and commonly used medications in the United States
