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Subject: Acetaminophen (N-Acetyl-p-Aminophenol; APAP)
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Nonopioid analgesic, antipyretic
Relief of pain, such as headaches and toothaches
Reduction of fever
Screen of urine: indication of exposure
Screen of serum: used to assess potential toxicity
Normal range: 5–20 μg/mL serum
Potentially toxic: >150 μg/mL measured 4 hours postdose
Serum/urine: colorimetric or immunoassay on automated chemistry analyzers
High bilirubin concentrations [>50 μg/mL] may cause false-positive results with immunoassay-based tests.
Plasma may be tested in place of serum. Anticoagulants such as EDTA and heparin do not generally interfere with the assay.
Do not use whole blood.
Serum/urine–HPLC or GC/MC
APAP is highly conjugated by glucuronidation and sulfation.
An assay that includes a hydrolysis step provides total APAP levels, which are not useful for assessing toxicity.