Abstract
Background: Acetaminophen (APAP) toxicity is commonly encountered in the Emergency
Department. Until 2004, treatment consisted of either oral N-acetylcysteine (NAC)
or filtered oral NAC administered intravenously (i.v.). Intravenous acetylcysteine
(Acetadote) is a new Food and Drug Administration-approved i.v. formulation of acetylcysteine
manufactured by Cumberland Pharmaceuticals in Nashville, Tennessee. Little post-marketing
data exists on the effectiveness and safety of i.v. acetylcysteine. Objectives: We
evaluated the clinical presentations and outcomes of patients treated with i.v. acetylcysteine
for APAP toxicity. Methods: We performed a retrospective chart review of patients
treated with i.v. acetylcysteine for APAP ingestion. The primary outcome measures
were: adverse reactions to and effectiveness of i.v. acetylcysteine, as defined by
elevation of transaminases, liver failure, renal failure, death, and hospital length
of stay (LOS). Data collected included: comorbidities, allergies, intentionality,
timing and dosing of i.v. acetylcysteine, hospital LOS, transaminases > 1000 IU/L,
development of liver failure requiring transplant, development of renal failure requiring
hemodialysis, death, and anaphylactoid reactions. Results: Sixty-four patients met
our study criteria. Overall, 16 (25%) patients developed transaminases > 1000 IU/L,
4 (6%) of them died and 2 (3%) received liver transplants. Of the 15 patients (23%)
treated within 8 h, none died or developed liver or renal failure, and only 1 developed
transient transaminase elevation > 1000 IU/L. In the patients treated outside of 8
h, the median LOS was 3 days, whereas the group treated within 8 h had a median LOS
of only 1 day. Six (9%) patients developed anaphylactoid reactions, 2 of whom received
the i.v. acetylcysteine bolus over 15 min. Five of these patients were treated pharmacologically
and completed treatment, and one had treatment discontinued for undocumented reasons.
Conclusion: Intravenous acetylcysteine seemed to be a safe and effective formulation
of N-acetylcysteine.
Keywords
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Article info
Publication history
Published online: November 21, 2008
Accepted:
May 8,
2008
Received in revised form:
April 29,
2008
Received:
August 30,
2007
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
