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If a patient is fortunate enough to seek out and obtain early medical attention (typically within 4 hours of the acute APAP ingestion), activated charcoal can be effective in limiting drug absorption, unless there are obvious contraindications, such as an unprotected airway or compromise of the gastrointestinal tract.70 Gastric lavage, activated charcoal ingestion, and vomiting induced by ipececauanha can all reduce drug absorption, but weak evidence suggests activated charcoal as the preferred method of gastrointestinal decontamination.71 The only patients who may benefit from activated charcoal beyond 4 hours of ingestion are those who ingested extended-release APAP formulations or co-ingestion of drugs that delay gastric emptying time.70 Use of activated charcoal is not without risks, however, and one must be wary of aspiration pneumonia, vomiting, diarrhea, constipation, ileus, and interference with the patients regular medications.72 NAC NAC is a cysteine prodrug and hepatic GSH precursor, and should be administered immediately as an antidote in patients with established APAP hepatotoxicity or those with high risk of developing this condition

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