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Updated: Jan 27, 2026

Generation of a Rat Model of Acute Liver Failure by Combining 70% Partial Hepatectomy and Acetaminophen
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Using the 150 rule to prevent hepatotoxicity from acetaminophen.

William A Nicholas1, Randy Moore

  • 1William A. Nicholas practices emergency medicine with EmCare in the Baylor Health System in Dallas, Tex. He also serves as a physician assistant in the Texas Army National Guard. Randy Moore practices at Wellness Pointe Family Health in Longview, Tex. The authors have disclosed no potential conflicts of interest, financial or otherwise.

JAAPA : Official Journal of the American Academy of Physician Assistants
|March 27, 2019
PubMed
Summary

Acetaminophen overdose can cause severe liver damage. Early treatment with N-acetylcysteine is crucial for preventing liver failure in both children and adults.

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Area of Science:

  • Toxicology
  • Hepatology
  • Pediatric Medicine

Background:

  • Acetaminophen (APAP) overdose is a leading cause of acute liver failure (ALF) in adults and children.
  • N-acetylcysteine (NAC) is the standard antidote, effectively mitigating APAP-induced hepatotoxicity when administered promptly.
  • Understanding optimal management protocols is critical for improving patient outcomes.

Observation:

  • A case study details the management of a 16-year-old female with a massive acetaminophen ingestion.
  • The clinical scenario highlights the application of the '150 rule' in guiding treatment decisions.
  • This rule assists in determining the necessity and timing of N-acetylcysteine administration.

Findings:

  • The 150 rule, a clinical nomogram, was utilized to assess the risk of hepatotoxicity based on acetaminophen levels and time since ingestion.
  • Prompt initiation of N-acetylcysteine therapy, guided by the 150 rule, was instrumental in preventing liver injury.
  • Successful management underscores the importance of timely and evidence-based interventions.

Implications:

  • This case illustrates the practical application of the 150 rule in managing acetaminophen overdose in adolescents.
  • Effective use of N-acetylcysteine can prevent progression to severe hepatotoxicity and liver failure.
  • The findings reinforce the critical role of rapid assessment and treatment protocols in pediatric toxicology.