Comparison of the 20-Hour Intravenous and 72-Hour Oral Acetylcysteine Protocols for the Treatment of Acute Acetaminophen Poisoning

Yarema, Mark; Johnson, David W.; Berlin, R; Sivilotti, Marco L.A.; Nettel-Aguirre, Alberto; Brant, Rollin; Spyker, Daniel A.; Bailey, Benoît; Chalut, Dominic; Lee, Jacques; Plint, Amy C.; Purssell, Roy; Rutledge, Tim; Seviour, Catherine A.; Stiell, Ian G.; Thompson, Margaret; Tyberg, Jeffrey; Dart, Richard C.; Rumack, Barry H.

doi:10.1016/j.annemergmed.2009.05.010

Cited by 102 publications

(63 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Though one recent study suggested that IV NAC may slightly decrease the risk of hepatotoxicity in patients starting treatment early [26], most toxicologists consider either formulation to provide adequate hepatic protection. Debate, however, exists over which formulation is preferable from a resource utilization standpoint.…”

Section: Discussionmentioning

confidence: 99%

“…While the FDA approved IV NAC formulation (Acetadote®) is more expensive, it is considered to be easier to use and better tolerated by patients. Despite its higher price, some authors have suggested that Acetadote® is actually more cost effective than oral NAC [16,[26][27][28][29]. The basis for this NAC N-acetylcysteine, PCC poison control center, LOS length of stay assertion is Acetadote's 20-h treatment regimen and a presumed decrease in hospitalization time.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Clinical Management of Acetaminophen Poisoning in a Community Hospital System: Factors Associated with Hospital Length of Stay

Offerman

2010

J. Med. Toxicol.

View full text Add to dashboard Cite

Acetaminophen (APAP) overdose is the most common pharmaceutical poisoning. The objective of this study was to examine the management of patients admitted for treatment of APAP overdose. Factors impacting hospital length of stay (LOS) were of particular interest. This was a retrospective cohort study of patients admitted to Kaiser Permanente Northern California hospitals for APAP overdose from July 2003 through December 2007. Medical records were abstracted for patient demographic data, key factors of overdose, California Poison Control System (CPCS) contact, data regarding hospital course, transfer for liver transplantation, and death. Four hundred thirty-five patients were included. The mean hospital LOS was 66.5 h (95% CI 62.1, 71.0). Four patients (0.9%) died. Eight patients (1.8%) were transferred for liver transplantation, but all of these patients later recovered without transplant. Of 289 cases eligible for placement on the RumackMatthew nomogram (acute ingestion with known time of ingestion <24 h and normal liver enzymes), 161 (55.7%) had APAP levels above the "200" line and 77 (26.6%) fell below the "150" line. CPCS was contacted in 295 cases (67.8%). Mean LOS in cases with CPCS consultation was 61.9 h (95% CI 57.2, 66.5 h) versus 76.3 h (95% CI 66.6, 86.0 h) in those without. LOS in cases treated with IV NAC was 67.1 h (95% CI 57.7, 76.5 h) versus 66.4 h (95% CI 61.2, 71.5 h) in cases treated with oral NAC. Many patients admitted for APAP overdose had serum APAP levels below the minimum toxicity level. Use of IV NAC did not impact hospital LOS. CPCS consultation appeared to decrease mean hospital LOS.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Clinical Management of Acetaminophen Poisoning in a Community Hospital System: Factors Associated with Hospital Length of Stay

Offerman

2010

J. Med. Toxicol.

View full text Add to dashboard Cite

show abstract

“…This therapy regime has also been accepted at our hospital and is being applied. There are many studies regarding acetaminophen poisoning comparing oral and IV NAC treatment in terms of costs, efficacy, or side-effects (15)(16)(17)(18)(19)(20)(21)(22). On the other hand, from a different perspective, we found that measuring blood acetaminophen level in developing countries, such as our country, where the blood levels of acetaminophen cannot be measured (cannot be measured at majority of hospitals) has lower cost than the total cost of all suspected poisonings with acetaminophen.…”

Section: Discussionmentioning

confidence: 59%

“…Knowing the time of ingestion and the amount of acetaminophen is important to start NAC treatment if needed (2). There are so many studies comparing IV therapy with oral therapy in terms of cost, effectiveness, or side-effects (7,(15)(16)(17)(18)(19)(20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%

Does Money Spent on Measuring Blood Levels of Acetaminophen Reduce the Cost of Treatment of Acetaminophen Poisoning?

Çebiçci¹,

Kilci²,

Bol³

et al. 2015

Erciyes Med J

View full text Add to dashboard Cite

Objective: Acetaminophen has been used as a safe analgesic and antipyretic. Acute ingestion of 10 g or more than 200 mg/kg as a single ingestion is accepted as toxic for adults. To show that money spent on measuring blood levels of acetaminophen reduces the cost of treatment of acetaminophen poisoning. Materials and Methods:The files of patients who were admitted to Kayseri Training and Research Hospital with pre-diagnosis of acetaminophen intoxication were examined over 6 months. One of the costs is based on the patients' own estimation of the toxic level of acetaminophen and the other is according to the measure of the toxic blood level of acetaminophen. The cost of the two groups was compared.Results: A total of 558 patients were diagnosed to have drug overdose during 6 months. Of these patients, 55 patients were evaluated as having acetaminophen overdose. According to the claims of 19 patients, acetaminophen level was calculated as toxic. However, only five patients' blood acetaminophen level was measured as toxic. Conclusion:Measuring blood acetaminophen level would be more accurate and advantageous in terms of both treatment planning and the cost of therapy in developing countries as in developed countries that have advanced healthcare system.

show abstract

“…Sri Lankan guidelines reflect this approach. There is some evidence that oral NAC is as effective as intravenous NAC [33]. If this can be confirmed it would provide additional options for earlier initiation of treatment in primary care and rural hospitals.…”

Section: Unintentional and Staggered Paracetamol Overdosesmentioning

confidence: 99%

Paracetamol overdose: Relevance of recent evidence for managing patients in Sri Lanka

Galappatthy

Dawson²

2015

Ceylon Med. J.

View full text Add to dashboard Cite

Comparison of the 20-Hour Intravenous and 72-Hour Oral Acetylcysteine Protocols for the Treatment of Acute Acetaminophen Poisoning

Cited by 102 publications

References 39 publications

The Clinical Management of Acetaminophen Poisoning in a Community Hospital System: Factors Associated with Hospital Length of Stay

The Clinical Management of Acetaminophen Poisoning in a Community Hospital System: Factors Associated with Hospital Length of Stay

Does Money Spent on Measuring Blood Levels of Acetaminophen Reduce the Cost of Treatment of Acetaminophen Poisoning?

Paracetamol overdose: Relevance of recent evidence for managing patients in Sri Lanka

Contact Info

Product

Resources

About