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.
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- 2005 Annual Report of the American Association of Poison Control Centers' national poisoning and exposure database.Clin Toxicol (Phila). 2006; 44: 803-932
- Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States.Ann Intern Med. 2002; 137: 947-954
- Efficacy of oral versus intravenous N-acetylcysteine in acetaminophen overdose: results of an open-label clinical trial.J Pediatr. 1998; 132: 149-152
- Oral or intravenous N-acetylcysteine: which is the treatment of choice for acetaminophen (paracetamol) poisoning?.J Toxicol Clin Toxicol. 1999; 37: 759-767
- Acetaminophen overdose: a 48-hour intravenous N-acetylcysteine treatment protocol.Ann Emerg Med. 1991; 20: 1058-1063
- Acetaminophen overdose: Incidence, diagnosis and management in 416 patients.Pediatrics. 1978; 62: 898-903
- Acetaminophen overdose: 662 cases with evaluation of oral acetylcysteine treatment.Arch Intern Med. 1981; 141: 380-385
- Mechanism of action of paracetamol protective agents in mice in vivo.Biochem Pharmacol. 1984; 33: 2995-3000
- Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose: analysis of the National Multicenter Study (1976 to 1985).N Engl J Med. 1988; 319: 1557-1562
- Hypersensitivity-like reactions to N-acetylcysteine.Vet Hum Toxicol. 1984; 26: 3-5
- Intravenous administration of oral N-acetylcysteine.Crit Care Med. 1998; 26: 40-43
- Intravenous N-acetylcysteine, use of an unapproved drug product: a two-year retrospective review [abstract].Vet Hum Toxicol. 1992; 24: 327
- What is the rate of adverse events after oral N-acetylcysteine administered by the intravenous route to patients with suspected acetaminophen poisoning?.Ann Emerg Med. 2003; 47: 741-750
- Anaphylactoid reactions to intravenous N-acetylcysteine: a prospective case controlled study.Accid Emerg Nurs. 2004; 12: 10-15
Published online: November 21, 2008
Accepted: May 8, 2008
Received in revised form: April 29, 2008
Received: August 30, 2007
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