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The initial purpose of the Rumack-Matthew nomogram was for acute ingestions of APAP and its use has not been validated for chronic ingestions, extended-release preparations or co-ingestions of APAP with other substances that may be hepatically cleared

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This first step is also the most critical rate-limiting step

Additionally, a meta-analysis of 46 randomized trials, including 171,244 participants, found that supplemental vitamin E, singly or in combination with other antioxidants, did not significantly alter the risk of all-cause mortality (126)

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