ACETAMINOPHEN-ACUTE

Acetaminophen is an analgesic and antipyretic agent used for the treatment of mild to moderate pain and for the reduction of fever (Prod Info TYLENOL(R) oral, 2010; Prod Info OFIRMEV(TM) intravenous infusion, 2010).
It is also used for moderate to severe pain in patients also receiving opioids adjunctively (Prod Info OFIRMEV(TM) intravenous infusion, 2010).
Poisoning has been reported in a child who ingested a "jello" made from dissolving the contents of acetaminophen gelcaps in water (Nasir & Walburn, 1997).

FORMS

INTRAVENOUS

10 mg/mL in a single-use 100 mL vial for injection (Prod Info OFIRMEV(TM) intravenous infusion, 2010).

ORAL

Capsules: 500 mg (Prod Info acetaminophen oral capsules, 2007)
Liquid: 160 mg/5 mL (Prod Info CHILDREN'S SILAPAP oral liquid, 2006)
Solution: 80 mg/0.8 mL, 160 mg/5 mL, 500 mg/15 mL (Prod Info TYLENOL(R) oral concentrated infant drops, 2009; Prod Info TYLENOL(R) SORE THROAT DAYTIME oral solution, 2007; Prod Info acetaminophen oral solution, 2002)
Suspension: 80 mg/0.8 mL (Prod Info TYLENOL(R) INFANTS' DROPS oral suspension, 2006)
Tablets: 325 mg and 500 mg; 80 mg and 160 mg (chewable); 650 mg (extended release) (McNeil-PPC, 2010; McNeil-PPC, 2010; Prod Info JR. TYLENOL(R) meltaway oral tablets, 2007; Prod Info TYLENOL(R) oral tablets, 2006; Prod Info QUICKMELTS(TM) oral tablets, 2004)

RECTAL

Suppository: 120 mg, 325 mg, 650 mg (Prod Info Acephen(TM) rectal suppositories, 2009; Prod Info ACEPHEN(TM) rectal suppositories, 2006; Prod Info ACEPHEN(TM) rectal suppositories, 2006a)

-CLINICAL EFFECTS

GENERAL CLINICAL EFFECTS

USES: Acetaminophen is a mild analgesic and antipyretic. It is available as a non-prescription single ingredient product, in many non-prescription combination products, and in prescription combination products (usually with an opioid).

PHARMACOLOGY: The exact mechanism of action is not known. Acetaminophen inhibits cyclooxygenase and this likely is responsible for at least some clinical effects.

TOXICOLOGY: In overdose, the usual metabolic pathways are overwhelmed, and acetaminophen is metabolized by CYP2E1 to a reactive metabolite. This metabolite can be detoxified by conjugation with glutathione, but when hepatic glutathione stores are depleted, the metabolite binds to macromolecules in the hepatocyte causing cell death and hepatic necrosis.

EPIDEMIOLOGY: Acetaminophen overdose is very common; there are several hundred deaths from acetaminophen poisoning annually in the United States.

WITH POISONING/EXPOSURE

MILD TO MODERATE TOXICITY: For the first day after ingestion, patients may be asymptomatic, or only develop nausea, vomiting, and abdominal pain. Elevation of serum transaminase (ALT, AST) may begin to develop about 24 hours after ingestion and can range from mild to marked (greater than 10,000 international units/L) with few other signs or symptoms. Aminotransferase elevations generally peak 2 to 3 days after ingestion.
SEVERE TOXICITY: Liver failure, including coagulopathy and hepatic encephalopathy, will occur. Patients may also have renal injury. Massive overdose (initial serum concentration greater than 500 mcg/mL) can produce coma, hyperglycemia and lactic acidosis. In patients who survive the overdose, both hepatic and renal function return to normal.

WITH THERAPEUTIC USE

Adverse effects following therapeutic administration are generally rare. Some patients may have gastrointestinal upset.

Editor's Note: An ERG guide with information appropriate to this material does not exist.

-FIRST AID

FIRST AID AND PREHOSPITAL TREATMENT

SUMMARY

In a retrospective study of 2091 children aged 1 to 6 years referred to a health care facility for acute acetaminophen overdose, 866 had acetaminophen levels obtained. Of these, 3 fell into the "probable risk" range and 6 were in the "possible risk" range on the nomogram. A strategy that referred only those children who potentially ingested more than 200 mg/kg of an adult preparation identified all children with levels in the "probable risk" range (Bond et al, 1994).
In a prospective study of 589 children referred to a health care facility after possibly ingesting greater than 140 mg/kg acetaminophen, 538 had acetaminophen level obtained. Of these 241 ingested an unknown amount, 189 ingested between 140 and 200 mg/kg, 65 between 200 and 300 mg/kg, and 41 more than 300 mg/kg. Eighty-three percent received gastrointestinal decontamination. Five children had toxic acetaminophen levels, 3 who ingested unknown amounts, and 2 who ingested 2500 and 421 mg/kg, respectively (Yerman et al, 1995).
These two studies provide support for treating children, less than 6 years of age, who ingest less than 200 mg/kg at home and referring those with larger ingestions for hospital treatment. If this strategy is employed at home, treatment with activated charcoal should be considered for children with ingestions of 200 mg/kg or greater.
For inadvertent ingestions, refer all patients 6 years of age or older to the hospital if the ingested amount is at least 200 mg/kg or 10 g (whichever is less), or the amount ingested is unknown. Acetaminophen serum level must be determined at 4 hours after ingestion or as soon as possible thereafter.

ACTIVATED CHARCOAL

PREHOSPITAL ACTIVATED CHARCOAL ADMINISTRATION

Consider prehospital administration of activated charcoal as an aqueous slurry in patients with a potentially toxic ingestion who are awake and able to protect their airway. Activated charcoal is most effective when administered within one hour of ingestion. Administration in the prehospital setting has the potential to significantly decrease the time from toxin ingestion to activated charcoal administration, although it has not been shown to affect outcome (Alaspaa et al, 2005; Thakore & Murphy, 2002; Spiller & Rogers, 2002).

In patients who are at risk for the abrupt onset of seizures or mental status depression, activated charcoal should not be administered in the prehospital setting, due to the risk of aspiration in the event of spontaneous emesis.
The addition of flavoring agents (cola drinks, chocolate milk, cherry syrup) to activated charcoal improves the palatability for children and may facilitate successful administration (Guenther Skokan et al, 2001; Dagnone et al, 2002).

CHARCOAL DOSE

Use a minimum of 240 milliliters of water per 30 grams charcoal (FDA, 1985). Optimum dose not established; usual dose is 25 to 100 grams in adults and adolescents; 25 to 50 grams in children aged 1 to 12 years (or 0.5 to 1 gram/kilogram body weight) ; and 0.5 to 1 gram/kilogram in infants up to 1 year old (Chyka et al, 2005).

Routine use of a cathartic with activated charcoal is NOT recommended as there is no evidence that cathartics reduce drug absorption and cathartics are known to cause adverse effects such as nausea, vomiting, abdominal cramps, electrolyte imbalances and occasionally hypotension (None Listed, 2004).

ADVERSE EFFECTS/CONTRAINDICATIONS

Complications: emesis, aspiration (Chyka et al, 2005). Aspiration may be complicated by acute respiratory failure, ARDS, bronchiolitis obliterans or chronic lung disease (Golej et al, 2001; Graff et al, 2002; Pollack et al, 1981; Harris & Filandrinos, 1993; Elliot et al, 1989; Rau et al, 1988; Golej et al, 2001; Graff et al, 2002). Refer to the ACTIVATED CHARCOAL/TREATMENT management for further information.
Contraindications: unprotected airway (increases risk/severity of aspiration) , nonfunctioning gastrointestinal tract, uncontrolled vomiting, and ingestion of most hydrocarbons (Chyka et al, 2005).

-RANGE OF TOXICITY

MINIMUM LETHAL EXPOSURE

CASE REPORTS

Of 11,195 cases of suspected acetaminophen overdose, 50 died, all adults. In 28 of these cases death could be definitely or probably attributed to acetaminophen. Mortality was significantly higher in patients who received NAC more than 16 hours postingestion (8/479 (1.67%) of those with toxic acetaminophen levels) than in those who received NAC within 16 hours (2 of 1559 (0.13%) with toxic acetaminophen levels) (Smilkstein et al, 1988).

MAXIMUM TOLERATED EXPOSURE

SUMMARY

ACUTE INGESTION: Prediction of toxicity based on the patient's history is unreliable.

Ingestions of 200 mg/kg OR 10 g WHICHEVER IS LESS are considered potentially toxic (Dart et al, 2006).
Significant toxicity can develop following adult ingestions of greater than 150 mg/kg (Hendrickson & Bizovi, 2008; Prescott, 1983) .

PEDIATRIC

ORAL

For inadvertent ingestions, children less than 6 years of age should be referred to a healthcare facility if the amount ingested is 200 mg/kg or more, or if the amount ingested is unknown. Acetaminophen serum concentration must be determined at 4 hours after ingestion or as soon as possible thereafter. Alcoholic or malnourished patients may be at risk at lower doses (Dart et al, 2006).

The table below indicates the maximum number of dosage units of acetaminophen a person might ingest to be at or below 200 mg/kg of body weight.

NUMBER OF DOSES OF ACETAMINOPHEN EQUIVALENT TO 200 MG/KG
AGE	AVERAGE WEIGHT (kg)	AVAILABLE DOSAGE FORM
AGE	AVERAGE WEIGHT (kg)	80 mg	120 mg	160 mg	325 mg	500 mg
less than 1 mo	3.25	8	5	4	2	1
1 mo	4	10	7	5	3	2
3 mo	5.7	14	10	7	4	2
6 mo	7.5	19	13	9	5	3
9 mo	8.9	22	15	11	6	4
12 mo	10	25	17	13	6	4
18 mo	11	28	18	14	7	4
2 yr	12	30	20	15	7	5
3 yr	14	35	23	18	9	6
4 yr	16	40	27	20	10	6
5 yr	18	45	30	23	11	7
6 yr	20	50	33	25	12	8
7 yr	22	55	37	28	14	9
8 yr	25	63	42	31	15	10
9 yr	28	70	47	35	17	11
10 yr	32	80	53	40	20	13
12 yr	40	100	67	50	25	16
14 yr	50	125	83	63	31	20

ASSUMPTIONS

The age-weight relationship is the result of the average of the 50th percentile weight for boys and girls at the given age (Behrman & Vaughn, 1983).
Example of dosage units are: 120-mg tablet, 120-mg wafer, 120-mg suppository, 120-mg/5 mL elixir, 120-mg/2.5 mL solution

HOW TO USE THE CHART

An 18-month-old, 11-kg child was estimated to have ingested 45 mL of a solution of acetaminophen containing 120 mg/2.5 mL by history. Is this child above or below the 200 mg/kg threshold?
Find 11 kg under weight column, read across to 120-mg dosage form = 18 dosage units. Eighteen dosage units x 2.5 mL/dosage unit = 45 mL

INTERPRETATION: Ingestion of 45 mL of acetaminophen solution (120 mg/2.5 mL) is equivalent to approximately 200 mg/kg in an 11-kg child.

It has been presumed that an acute acetaminophen dose of 200 milligrams/kilogram in children is a toxic dose, capable of producing liver toxicity. It is postulated that a toxic dose for a 5-year-old child, based on liver size ratio compared with an adult, to be 187.5 mg/kg. Predicted toxic dose for a younger child would be even higher. The author suggests raising the previously accepted toxic dose of 150 mg/kg for children less than 6 years old and thus decreasing the number of patients receiving gastrointestinal decontamination and serum concentration determinations (Tenenbein, 2001).
Of 417 pediatric acetaminophen overdoses, 55 (13%) had toxic plasma levels, resulting in hepatotoxicity (SGOT greater than 1000 units/L) in 3 (5.5%).
COMPARISON WITH ADULTS: A comparison with 639 adult cases showed toxic levels in 23.2% and hepatotoxicity in 29% of those (Rumack, 1984). The increased glutathione turnover rate in children may result in greater detoxification of acetaminophen.
In a prospective, observational study (n=1019) of acute pediatric overdose ingestions of acetaminophen (excluding extended-release preparations) of up to 200 mg/kg, it was found that with home monitoring alone these patients do not develop signs or symptoms of hepatic injury at 72-hour follow-up (Mohler et al, 2000).
CASE REPORT: An 18-month-old child developed metabolic acidosis (pH 7.14; PvCO2, 35; base excess, -17) after ingesting twenty (20) 500-mg acetaminophen capsules (total dose 10 g). Except for a mild elevation of her AST level, there was no evidence of hepatotoxicity. Following administration of NAC and sodium bicarbonate, the patient completely recovered, without sequelae, approximately 20 hours postingestion (Steelman et al, 2004).

INTRAVENOUS

CASE REPORT: A 5-month-old child, with intussusception, received intravenous paracetamol 15 mg/kg following surgery. Eight hours later, the patient inadvertently received an intravenous paracetamol dose of 75 mg/kg (520 mg). She did not receive N-acetylcysteine (NAC) initially and, within 24 hours, developed elevated liver enzyme concentrations (peak ALT 2819 international units/L and peak AST 4294 international units/L at 48 hours after overdose). NAC was initiated 24 hours after the overdose, and the patient's liver enzymes gradually improved. She was discharged 2 days later. This patient's liver injury was not completely consistent with APAP-induced hepatotoxicity, as the bilirubin was elevated (29 micromol/L) at 6 hours after the overdose (normal alkaline phosphatase and ALT at that time). Another infant (6-months-old), who underwent inguinal hernia repair, inadvertently received 300 mg paracetamol (75.8 mg/kg) intravenously instead of the intended 30 mg. The patient immediately received NAC continuously for 20 hours, remained asymptomatic with normal liver enzymes, and was discharged 30 hours post-operatively (Beringer et al, 2011).
CASE REPORT: A 36-month-old chronically malnourished child, weighing 10 kg, developed hepatotoxicity (peak AST 1353 units/L and ALT 1378 units/L 48 hours after overdose) after inadvertently receiving 1500 mg (150 mg/kg) of IV paracetamol, instead of the prescribed dose of 150 mg (15 mg/kg). The patient recovered after receiving the standard dosing regimen of IV N-acetylcysteine, and was discharged 132 hours post-overdose (Berling et al, 2012).

ADULT

CASE REPORT: A 22-year-old man intentionally ingested 15 to 25 hydrocodone/acetaminophen tablets (5 mg/500 mg) and presented to the emergency department 16 hours postingestion after experiencing persistent nausea and vomiting. His acetaminophen concentration, at the time of presentation, was less than 10 mcg/mL and his liver enzyme concentrations were normal (AST 31 units/L (reference range, 0 to 40 units/L), ALT 34 units/L (reference range, 0 to 40 units/L)). At this time, he was transferred to an inpatient psychiatric unit where he continued to experience nausea and vomiting as well as diffuse abdominal pain. Approximately 29 and 36 hours postingestion, repeat laboratory analyses revealed an acetaminophen concentration of less than 10 mcg/mL and an AST of 45 and 150, respectively, and an ALT of 61 and 204, respectively. Due to increasing transaminase concentrations and persistent nausea and abdominal pain over the next 2 days, IV NAC was administered for 16 hours. The patient's liver enzyme concentrations decreased with complete symptom resolution approximately 77 hours postingestion (Bebarta et al, 2014).
CASE REPORT: A 27-year-old woman presented to the hospital following an intentional ingestion of 11 g of paracetamol (196 mg/kg). A paracetamol concentration, obtained 4 hours postingestion, was 129 mg/L, and IV NAC was administered. Within 36 hours postingestion, the patient developed jaundice (total bilirubin 145 mcmol [baseline 35 mcmol]), but liver enzymes and prothrombin time were normal. A complete blood count indicated mild anemia (hemoglobin 96 g/L) and further analysis of the bilirubin determined it to be primarily unconjugated, suggesting the development of hemolysis with a presentation of significant jaundice secondary to paracetamol overdose. Further investigation of the patient revealed that she was G6PD-deficient. Four days postingestion, the patient's elevated bilirubin concentration began to decrease (42 mcmol) (Phillpotts et al, 2014).
CASE REPORT: A 30-year-old woman with a history of G6PD deficiency presented approximately 12 hours after an intentional acute ingestion of 10 g acetaminophen. Laboratory data revealed an acetaminophen level of 72.3 mcg/mL, a hemoglobin level of 13.6 g/dL, a mildly elevated ALT, and evidence of indirect bilirubinemia. The patient was started on an IV acetylcysteine infusion. Forty-two hours later, repeat laboratory data demonstrated AST and ALT levels of 9118 and 8796 International Units/L, an INR of 3.4, a haptoglobin level of 25 mg/dL, a LDH level of 2250 International Units/L, an unconjugated bilirubin level of 6.9 mg/dL, a total bilirubin level of 10.1 mg/dL, and her urinalysis revealed bilirubinuria without hematuria, all of which is consistent with hemolytic anemia. A repeat serum acetaminophen level was negative. Although her liver function and INR improved over the next 4 days, her anemia worsened, with her hemoglobin level decreasing to a nadir of 8.6 g/dL (Rickner & Simpson, 2015).

Carcinogenicity Ratings for CAS103-90-2 :

ACGIH (American Conference of Governmental Industrial Hygienists, 2010): Not Listed
EPA (U.S. Environmental Protection Agency, 2011): Not Listed
IARC (International Agency for Research on Cancer (IARC), 2016; International Agency for Research on Cancer, 2015; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2010; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2010a; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2008; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2007; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2006; IARC, 2004): 3 ; Listed as: Paracetamol (Acetaminophen)

3 : The agent (mixture or exposure circumstance) is not classifiable as to its carcinogenicity to humans. This category is used most commonly for agents, mixtures and exposure circumstances for which the evidence of carcinogenicity is inadequate in humans and inadequate or limited in experimental animals. Exceptionally, agents (mixtures) for which the evidence of carcinogenicity is inadequate in humans but sufficient in experimental animals may be placed in this category when there is strong evidence that the mechanism of carcinogenicity in experimental animals does not operate in humans. Agents, mixtures and exposure circumstances that do not fall into any other group are also placed in this category.

NIOSH (National Institute for Occupational Safety and Health, 2007): Not Listed
MAK (DFG, 2002): Not Listed
NTP (U.S. Department of Health and Human Services, Public Health Service, National Toxicology Project ): Not Listed

TOXICITY AND RISK ASSESSMENT VALUES

EPA IRIS

EPA Risk Assessment Values for CAS103-90-2 (U.S. Environmental Protection Agency, 2011):

Not Listed

TOXICITY VALUES

ANIMAL DATA
- LD50- (ORAL)GUINEA_PIG:
- LD50- (ORAL)MOUSE:
- LD50- (SUBCUTANEOUS)MOUSE:
- LD50- (ORAL)RAT:

-STANDARDS AND LABELS

WORKPLACE STANDARDS

ACGIH TLV Values for CAS103-90-2 (American Conference of Governmental Industrial Hygienists, 2010):

Not Listed

AIHA WEEL Values for CAS103-90-2 (AIHA, 2006):

Not Listed

NIOSH REL and IDLH Values for CAS103-90-2 (National Institute for Occupational Safety and Health, 2007):

Not Listed

OSHA PEL Values for CAS103-90-2 (U.S. Occupational Safety, and Health Administration (OSHA), 2010):

Not Listed

OSHA List of Highly Hazardous Chemicals, Toxics, and Reactives for CAS103-90-2 (U.S. Occupational Safety and Health Administration, 2010):

Not Listed

ENVIRONMENTAL STANDARDS

EPA CERCLA, Hazardous Substances and Reportable Quantities for CAS103-90-2 (U.S. Environmental Protection Agency, 2010):

Not Listed

EPA CERCLA, Hazardous Substances and Reportable Quantities, Radionuclides for CAS103-90-2 (U.S. Environmental Protection Agency, 2010):

Not Listed

EPA RCRA Hazardous Waste Number for CAS103-90-2 (U.S. Environmental Protection Agency, 2010b):

Not Listed
Editor's Note: The D, F, and K series waste numbers and Appendix VIII to Part 261 -- Hazardous Constituents were not included. Please refer to 40 CFR Part 261.

EPA SARA Title III, Extremely Hazardous Substance List for CAS103-90-2 (U.S. Environmental Protection Agency, 2010):

Not Listed

EPA SARA Title III, Community Right-to-Know for CAS103-90-2 (40 CFR 372.65, 2006; 40 CFR 372.28, 2006):

Not Listed

DOT List of Marine Pollutants for CAS103-90-2 (49 CFR 172.101 - App. B, 2005):

Not Listed

EPA TSCA Inventory for CAS103-90-2 (EPA, 2005):

Listed as: Acetamide, N-(4-hydroxyphenyl)-

LABELS

NFPA

NFPA Hazard Ratings for CAS103-90-2 (NFPA, 2002):

Not Listed

-PERSONAL PROTECTION

SUMMARY

Editor's Note: An ERG guide with information appropriate to this material does not exist.

PROTECTIVE CLOTHING

CHEMICAL PROTECTIVE CLOTHING. Search results for CAS 103-90-2.

Specific recommendations and test data for this chemical were not found in the available manufacturers' product literature. A complete list of consulted manufacturers and references is presented below.

-PHYSICAL HAZARDS

FIRE HAZARD

SUMMARY

Editor's Note: An ERG guide with information appropriate to this material does not exist.

FLAMMABILITY CLASSIFICATION

NFPA Flammability Rating for CAS103-90-2 (NFPA, 2002):

Not Listed

FIRE CONTROL/EXTINGUISHING AGENTS

Editor's Note: An ERG guide with information appropriate to this material does not exist.

NFPA Extinguishing Methods for CAS103-90-2 (NFPA, 2002):

Not Listed

REACTIVITY HAZARD

Storage: Airtight container and protect from light (JEF Reynolds , 1991)

EVACUATION PROCEDURES

SUMMARY

Editor's Note: An ERG guide with information appropriate to this material does not exist.

AIHA ERPG Values for CAS103-90-2 (AIHA, 2006):

Not Listed

DOE TEEL Values for CAS103-90-2 (U.S. Department of Energy, Office of Emergency Management, 2010):

Not Listed

AEGL Values for CAS103-90-2 (National Research Council, 2010; National Research Council, 2009; National Research Council, 2008; National Research Council, 2007; NRC, 2001; NRC, 2002; NRC, 2003; NRC, 2004; NRC, 2004; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; United States Environmental Protection Agency Office of Pollution Prevention and Toxics, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; 62 FR 58840, 1997; 65 FR 14186, 2000; 65 FR 39264, 2000; 65 FR 77866, 2000; 66 FR 21940, 2001; 67 FR 7164, 2002; 68 FR 42710, 2003; 69 FR 54144, 2004):

Not Listed

NIOSH IDLH Values for CAS103-90-2 (National Institute for Occupational Safety and Health, 2007):

Not Listed

CONTAINMENT/WASTE TREATMENT OPTIONS

SUMMARY

Editor's Note: An ERG guide with information appropriate to this material does not exist.

SMALL LEAK/SPILL

Editor's Note: An ERG guide with information appropriate to this material does not exist.

LARGE LEAK/SPILL

Editor's Note: An ERG guide with information appropriate to this material does not exist.

-PHYSICAL/CHEMICAL PROPERTIES

MOLECULAR WEIGHT

151.16 (Prod Info OFIRMEV(TM) intravenous infusion, 2010)

DESCRIPTION/PHYSICAL STATE

Acetaminophen exists as white, odorless, bitter tasting crystals or crystalline powder (Prod Info acetaminophen, codeine phosphate oral solution, 2006) that is freely soluble in alcohol and in propylene glycol, soluble in acetone and in boiling water, very slightly soluble in chloroform, and sparingly soluble in glycerol and water (JEF Reynolds , 1991). It has an osmolality of approximately 290 mOsm/kg (Prod Info OFIRMEV(TM) intravenous infusion, 2010).

approximately 5.5 (Prod Info OFIRMEV(TM) intravenous infusion, 2010)

SOLUBILITY

IN WATER

Sparingly soluble in water; soluble in boiling water (JEF Reynolds , 1991).

IN ORGANIC SOLVENTS

Alcohol: Freely soluble
Acetone: Soluble
Glycerol: Sparingly soluble
Propylene Glycol: Freely soluble
Chloroform: Very slightly soluble

-REFERENCES

GENERAL BIBLIOGRAPHY

40 CFR 372.28: Environmental Protection Agency - Toxic Chemical Release Reporting, Community Right-To-Know, Lower thresholds for chemicals of special concern. National Archives and Records Administration (NARA) and the Government Printing Office (GPO). Washington, DC. Final rules current as of Apr 3, 2006.

40 CFR 372.65: Environmental Protection Agency - Toxic Chemical Release Reporting, Community Right-To-Know, Chemicals and Chemical Categories to which this part applies. National Archives and Records Association (NARA) and the Government Printing Office (GPO), Washington, DC. Final rules current as of Apr 3, 2006.

49 CFR 172.101 - App. B: Department of Transportation - Table of Hazardous Materials, Appendix B: List of Marine Pollutants. National Archives and Records Administration (NARA) and the Government Printing Office (GPO), Washington, DC. Final rules current as of Aug 29, 2005.

62 FR 58840: Notice of the National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances - Proposed AEGL Values, Environmental Protection Agency, NAC/AEGL Committee. National Archives and Records Administration (NARA) and the Government Publishing Office (GPO), Washington, DC, 1997.

65 FR 14186: Notice of the National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances - Proposed AEGL Values, Environmental Protection Agency, NAC/AEGL Committee. National Archives and Records Administration (NARA) and the Government Publishing Office (GPO), Washington, DC, 2000.

65 FR 39264: Notice of the National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances - Proposed AEGL Values, Environmental Protection Agency, NAC/AEGL Committee. National Archives and Records Administration (NARA) and the Government Publishing Office (GPO), Washington, DC, 2000.

65 FR 77866: Notice of the National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances - Proposed AEGL Values, Environmental Protection Agency, NAC/AEGL Committee. National Archives and Records Administration (NARA) and the Government Publishing Office (GPO), Washington, DC, 2000.

66 FR 21940: Notice of the National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances - Proposed AEGL Values, Environmental Protection Agency, NAC/AEGL Committee. National Archives and Records Administration (NARA) and the Government Publishing Office (GPO), Washington, DC, 2001.

67 FR 7164: Notice of the National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances - Proposed AEGL Values, Environmental Protection Agency, NAC/AEGL Committee. National Archives and Records Administration (NARA) and the Government Publishing Office (GPO), Washington, DC, 2002.

68 FR 42710: Notice of the National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances - Proposed AEGL Values, Environmental Protection Agency, NAC/AEGL Committee. National Archives and Records Administration (NARA) and the Government Publishing Office (GPO), Washington, DC, 2003.

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National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Selenium Hexafluoride (Proposed). United States Environmental Protection Agency. Washington, DC. 2006f. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020ec55&disposition=attachment&contentType=pdf. As accessed 2010-08-16.

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Product Information: ACEPHEN(TM) rectal suppositories, acetaminophen rectal suppositories. G&W Laboratories,Inc, South Plainfield, NJ, 2006.

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