Unique Plan Description: Acetylcysteine (Mucomyst) ORAL Protocol
Plan Selection Display: Acetylcysteine (Mucomyst) ORAL Protocol
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2021-04-16 07:16:25
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-07-12 21:18:33
Available at all facilities: Yes

Acetylcysteine (Mucomyst) ORAL Protocol
Laboratory
	ALT
		T;N, Stat, spec type = Blood
	AST
		T;N, Stat, spec type = Blood
	Bilirubin Total
		T;N, Stat, spec type = Blood
	INR - MH/WH/JE
		T;N, Stat, spec type = Blood
	Prothrombin Time (PT) - FH
		T;N, Stat, spec type = Diagnostic Blood
		T;N, Stat, spec type = Therapeutic Blood
	Comprehensive Metabolic Panel
		T;N, Stat, spec type = Blood
	Acetaminophen Level
		T;N, Stat, spec type = Blood
	ALT
		T;N+720, Timed, Q12H, spec type = Blood
	AST
		T;N+720, Timed, Q12H, spec type = Blood
	Bilirubin Total
		T;N+720, Timed, Q12H, spec type = Blood
	INR - MH/WH/JE
		T;N+720, Timed, Q12H, spec type = Blood
	Prothrombin Time (PT) - FH
		T;N+720, Q12H, Timed, spec type = Diagnostic Blood
		T;N+720, Q12H, Timed, spec type = Therapeutic Blood
	Basic Metabolic Panel
		T;N+720, Timed, Q12H, spec type = Blood
	Acetaminophen Level
		T;N+720, Timed, Q12H, spec type = Blood
Medications
		Contact Poison Control Center 1-800-222-1222 to obtain patient specific treatment guidelines(NOTE)*
	Mucomyst 20% oral use
		140 mg/kg, Solution, By Mouth, Once
			Comment: Dilute with cola or juice to a 5% concentration.  If given via NG, May dilute with water.  If patient vomits any dose of acetylcysteine within 1 hour of administration, repeat the dose. If vomiting persists, check the dilution of the acetylcysteine, put on ice and cover with lid. Have patient drink through straw.  Notify MD if patient unable to retain acetylcysteine after 2nd attempt or has persistent problems retaining acetylcysteine, contact MD.  Consider Acetadote (IV acetlycysteine) therapy.
		70 mg/kg, Solution, By Mouth, Q4H, T;N+240, 17 Dose(s)/Time(s)
			Comment: Dilute with cola or juice to a 5% concentration.  If given via NG, May dilute with water.  If patient vomits any dose of acetylcysteine within 1 hour of administration, repeat the dose. If vomiting persists, check the dilution of the acetylcysteine, put on ice and cover with lid. Have patient drink through straw.  Notify MD if patient unable to retain acetylcysteine after 2nd attempt or has persistent problems retaining acetylcysteine, contact MD.  Consider Acetdote (IV acetlycysteine) therapy. REFERENCE TEXT:   After 20 hours consider the following:  1.  If APAP level is negative and LFTs are normal or improving from admission values, consider discontinuing  Acetylcysteine.  2.  If APAP is detectable and/or LFTs are abnormal continue Acetylcysteine until APAP is undectable and LFTs are improving.  3.  If major hepatotoxicity is present or develops during treatment, continue Acetylcysteine until significant improvement in hepatic function, transplantation or death.
	ondansetron
		4 mg, Injection, IV PUSH, Q8H, duration: 3 Dose(s)/Time(s)
		0.1 mg/kg, Injection, IV PUSH, Q8H, duration: 3 Dose(s)/Time(s)
			Comment: max 4 mg
		4 mg, Injection, IV PUSH, Q8H, PRN for nausea, T+1;N
		0.1 mg/kg, Injection, IV PUSH, Q8H, PRN for nausea
			Comment: max 4 mg
Patient Care
	Notify MD
		T;N, If Patient Unable to retain oral acetylcysteine after second attempt
	No Acetaminophen
		T;N

Allergy Reaction Protocol
Activity
	Position Patient
		T;N
			Comment: If hypotensive, keep patient supine with legs elevated or bed in trendelenberg
IV Solutions
	Sodium Chloride 0.9%
		500 mL, IV, Routine, Bolus
		1,000 mL, IV, Routine, 30 ml/hr
Medications
	Benadryl
		50 mg, Injection, IV Push, Once, PRN, allergic reaction, NOW
		25 mg, Injection, IV Push, Once, PRN, allergic reaction, NOW
	Decadron (MH/WH)
		20 mg, Injection, IV PUSH, Once, PRN, allergic reaction
	SOLU-Medrol
		125 mg, Injection, IV Push, Once
	EPINEPHrine
		0.5 mg, Injection, SUBCUTANEOUS, Once
		0.5 mg, Injection, IM-Intramuscular, Once
		0.5 mg, Injection, SUBCUTANEOUS, Q10MIN, PRN, anaphylaxis, 3 Dose(s)/Time(s)
		0.5 mg, Injection, IM-Intramuscular, Q10MIN, PRN, anaphylaxis, 3 Dose(s)/Time(s)
		For infants and children up to age 12 < 30kg(NOTE)*
		0.01 mg/kg, Injection, SUBCUTANEOUS, Q5MIN, PRN, anaphylaxis, 3 Dose(s)/Time(s)
		0.01 mg/kg, Injection, IM-Intramuscular, Q5MIN, PRN, anaphylaxis, 3 Dose(s)/Time(s)
		For infants and children up to age 12 > or equal to 30kg(NOTE)*
		0.3 mg, Injection, SUBCUTANEOUS, Q5MIN, PRN, anaphylaxis, 3 Dose(s)/Time(s)
		0.3 mg, Injection, IM-Intramuscular, Q5MIN, PRN, anaphylaxis, 3 Dose(s)/Time(s)
Patient Care
	Pharmacy Consult
		T;N, Allergy Reaction Protocol was entered on this patient, please verify allergy, and add allergen to patient allergies in medical record
	Discontinue Medication
		T;N, Discontinue IV medication or infusion and remove tubing
	Notify MD
		T;N, Contact PCP for additional orders

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase